BackgroundPrevious studies evaluating association between circulating tumor cells (CTCs) and clinical outcomes in hepatocellular carcinoma (HCC) have shown inconsistent results due to suboptimal detection methods and patient heterogeneity.MethodsPatients undergoing surgery for early-stage HCC were prospectively enrolled. The CTC numbers were determined using a tapered slit platform, which detects CTCs based on the cell size and morphology. Survival and recurrence were evaluated, and Cox proportional hazards models were used to demonstrate the prognostic significance of CTC.ResultsOf 105 patients, 25 had increased CTC numbers after surgery (Delta CTC>0, defined as positive) and a significantly higher level of recurrence (p=0.042). A positive Delta CTC was seen to be an independent predictor of recurrence (hazard ratio 2.28), along with hepatitis B virus infection, alanine aminotransferase level, and the presence of satellite nodules (all p<0.05). Subgroup analyses showed that a positive Delta CTC was associated with lower survival and higher recurrence among patients with low alpha-fetoprotein levels and cirrhosis (all p<0.05).ConclusionCalculation of Delta CTC based on the physical properties of the cells is predictive of recurrence in patients with early HCC undergoing surgery.