BACKGROUND: The highly sensitive technique of reverse transcriptase-polymerase chain reaction(RT-PCR) has been used to detect circulating tumor cells. This study was undertaken to detect circulating hepatocellular carcinoma cells and to evaluate their potential clinical implication in HCC patients.
METHODS: Subjects included 65 patients with primary HCC, 22 patients with hepatitis B and liver cirrhosis, 12 patients with metastatic liver cancer, 11 patients with hepatic hemangioma, and 20 healthy volunteers. AFPmRNA and melanoma antigen gene (MAGE-1) mRNA in peripheral blood samples were tested using nested RT-PCR. 
RESULTS: The positive rates of MAGE-1mRNA and AFPmRNA were 41.5% (27) and 53.8% (35), respectively in the HCC patients. In 64.6%(42) of the 65 patients, there was at least one positive marker. The positive rate of AFPmRNA or MAGE-1mRNA was correlated with portal thrombosis, nodules of tumor, tumor diameter and TNM stage (P<0.05). Samples from 4 (33.3%) of the 12 patients with metastatic liver cancer were MAGE-1mRNA positive, samples from 3(13.6%) of the 22 patients with cirrhosis AFPmRNA positive, and the others were both negative.
CONCLUSIONS: Nested RT-PCR is a sensitive and reliable method for detecting circulating HCC cells. A two-marker RT-PCR assay with a liver-specific AFP marker and a cancer specific MAGE-1 marker may be a promising tool for detecting blood disseminated HCC cells with a better sensitivity and specificity than a single marker RT-PCR.