Circulating and intratumoral macrophages in patients with hepatocellular carcinoma: Correlation with therapeutic approach

Background: Hepatocellular carcinoma arises in an environment of chronic injury, and wound-healing responses may vary by treatment. Methods: Peripheral blood myeloid populations were quantified in 39 patients with hepatocellular carcinoma treated with surgical or endoluminal therapy. Macrophages were quantified in tissue when available. Results: There was a similar expansion of myeloid populations after operative procedures compared with endoluminal treatments. Immunostaining for CD68 revealed no significant differences in the number of macrophages within benign versus malignant tumors and when tumors were compared with nontumor liver. Cytotoxic CD8+ T cells were rare within tumors compared with the surrounding liver (P <.0001). Progression-free survival was reduced in patients with preoperative peripheral blood monocyte expansion (P <.05). Conclusions: These data provide preliminary evidence of poor prognostic significance of elevated peripheral blood monocyte counts. We propose that the inflammatory environment of hepatocellular carcinoma may represent a consistent feature to both predict and alter the course of disease.