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Background and aims  Studies suggest that mutations in the  CTNNB1  gene are predictive of response to immunotherapy, an emerging therapy for advanced hepatocellular carcinoma (HCC). Analysis of circulating tumor DNA (ctDNA) offers the possibility of serial non-invasive mutational profiling of tumors. Combining tumor tissue and ctDNA analysis may increase the detection rate of mutations.  This study aimed to evaluate the frequency of the  CTNNB1  p.T41A mutation in ctDNA and tumor samples from HCC patients and to evaluate the concordance rates between plasma and tissue. We further evaluated changes in ctDNA after various HCC treatment modalities and the impact of the  CTNNB1  p.T41A mutation on the clinical course of HCC.    Methods  We used droplet digital PCR to analyze plasma from 95 patients and the corresponding tumor samples from 37 patients during 3 years follow up.    Results  In tumor tissue samples, the mutation rate was 8.1% (3/37). In ctDNA from HCC patients, the  CTNNB1  mutation rate was 9.5% (9/95) in the pre-treatment samples. Adding results from plasma analysis to the subgroup of patients with available tissue samples, the mutation detection rate increased to 13.5% (5/37). There was no difference in overall survival according to  CTNNB1  mutational status. Serial testing of ctDNA suggested a possible clonal evolution of HCC or arising multicentric tumors with separate genetic profiles in individual patients.    Conclusion  Combining analysis of ctDNA and tumor tissue increased the detection rate of  CTNNB1  mutation in HCC patients. A liquid biopsy approach may be useful in a tailored therapy of HCC.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12885-021-08103-0.

Combining tissue and circulating tumor DNA increases the detection rate of a CTNNB1 mutation in hepatocellular carcinoma