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Circulating Hepatocellular Cells are a Bad Prognostic Factor for HCC Patients. BACKGROUND/AIMS: Circulating hepatocellular carcinoma cells (CHCCs) may be detected by reverse transcription-polymerase chain reaction (RT-PCR). We investigated the relationship between CHCCs and hepatoma patients' survival period after different managements. METHODOLOGY: Peripheral blood (5 ml) samples were obtained from 93 patients with hepatocellular carcinoma (HCC), and from 33 control subjects (9 with liver cirrhosis after hepatitis B, 14 with chronic hepatitis B, 10 with healthy people) between January 1st, 2009 and December 31, 2012. To detect CHCCs in peripheral blood, alpha-fetoprotein (AFP) messenger RNA (mRNA) was amplified from total RNA extracted from whole blood by RT-PCR. RESULTS: AFPmRNA was detected in 49 blood samples from the HCC patients (49/93, 53.0%). In contrast, there were no clinical control subjects whose samples showed detectable AFPmRNA. The presence of AFPmRNA in blood seemed to be correlated with the tumor stage (by TNM classification) of HCC, the serum AFP value, and the presence of intrahepatic metastasis, portal vein thrombosis, tumor diameter and/or distant metastasis. CONCLUSIONS: The presence of AFP mRNA in peripheral blood may be an indicator of CHCCs, which might predict hematogenous spreading metastasis in patients with HCC and may be as a bad prognostic factor for HCC patients.