Telomerase activity as a predictive marker for recurrence of hepatocellular carcinoma after hepatectomy

Background: Expression of telomerase activity and stabilization of telomeres are concomitant with attainment of immortality in tumor cells. Telomerase activity levels in hepatocellular carcinoma (HCC) may serve as a predictive marker for recurrence after surgery. Methods: Telomerase activity levels in HCC were measured in 37 patients undergoing hepatectomy by the telomeric repeat amplification protocol. The clinicopathologic factors and telomerase activity were analyzed to identify factors that were important in affecting recurrence of HCC and recurrence-free survival. Results: Telomerase activity was detected in 23 patients (62.2%), and was not significantly associated with seven other HCC-related factors. After a median follow-up of 34 months, 24 patients (64.9%) had recurrence of HCC. In univariate analyses, telomerase activity of more than 20 total product generated (TPG) and portal vein invasion were found to be significantly related to a shorter time to recurrence. Multivariate analysis demonstrated that telomerase activity (>20 TPG) was significantly related to an increased risk of recurrence (relative risk 2.36, 95% confidence interval 1.03 to 5.43, P = 0.04). Conclusions: Telomerase activity can be identified as an independent predictor for recurrence after resection of HCC.