Hepatocellular carcinoma specific graded prognostic assessment can predict outcomes for patients with brain metastases from hepatocellular carcinoma

Abstract

Stratifying patients with brain metastasis (BM) from hepatocellular carcinoma (HCC) by prognostic factors can be useful when making treatment decisions. Nevertheless, a diagnosis-specific graded prognostic assessment (GPA) for HCC has not been well established. We retrospectively reviewed the data from 118 HCC patients newly diagnosed with BM at the Yonsei University Health System between 1985 and 2011. After univariate and multivariate analyses of prognostic factors, those shown to significantly affect survival were used to develop a HCC-specific GPA (HCC-GPA) index. The median overall survival after BM in all patients was 6.1 weeks (95% confidence interval 4.8-7.4 weeks). Using the prognostic factors identified via multivariate analysis, we developed a HCC-GPA index, including number of brain metastases (single: 0.5, multiple: 0 points), alpha-feto protein (<400 ng/mL: 0.5, ≥400 ng/mL: 0 points), and Child-Pugh-Score (A: 3, B: 2, C: 0 points). There were no survival differences for age, sex, performance status, and time interval from initial diagnosis to development of BM. Median survival times from BM were discriminable when applying the HCC-GPA scoring system: 1.7, 3.2, 7.9, and 27.0 weeks for HCC-GPA scores of 0-1.0 (N = 16), 1.5-2.5 (N = 32), 3.0-3.5 (N = 49), and 4.0 (N = 21), respectively (P < 0.001). Although the prognoses of patients with BM from HCC are dismal, the newly developed HCC-GPA index can be used to discriminate the expected prognoses thereof. Moreover, the index may hold value as a tool for selecting patients who may be good candidates for active local treatment.

Tumor markers for early diagnosis for brain metastasis of hepatocellular carcinoma: A case series and literature review for effective loco-regional treatment

“…4,5,[7][8][9] Consistent with previous reports, our case series showed a median survival period of 3 d in the non-treated group although it depends on the timing of the diagnosis. In our cases, Case 1, 2, 5, and 8 showed rapid progression of brain metastases after the diagnosis of extrahepatic metastatic lesions (median of 13.5 months) in lung or lymphnodes.…”

“…[4][5][6][7] The prognosis of these patients is poor with survival period of a few weeks. 4,5,[7][8][9] Therefore, brain metastasis is considered as the terminal state of patients with HCC. In addition, various neurologic symptoms including headache, vomiting, hemiparesis, diplopia, hemianopsia, dysarthria, gait disturbance, and seizure affect their quality of life (QOL), and re-bleeding from the tumors cause a worse prognosis.…”

Brain metastases from hepatocellular carcinoma: recent advances and future avenues

“…The first large retrospective study published in 1998 by Kim et al found that only seven of 3,100 HCC patients had intracranial metastases [11]. On the basis of data from 10,615 patients recorded in the Yonsei University Health System between 1973 and 2001, Lim et al suggested that the incidence had increased to 1.1% [12]. Similarly, Shao et al assessed 158 patients with advanced HCC who were treated with antiangiogenic targeted therapy at National Taiwan University Hospital between 2005 and 2009, and reported an increase in incidence to 7% [18].…”

“…BMHCC patients generally have advanced liver disease and a high percentage of synchronous extra-cerebral metastases (ranging from 80.5% to 93.2%), including lung (69.4-75.6%), followed by bone (18-25.8%), lymph nodes, and adrenal glands [2, 3, 12, 30–36]. On the other hand, BMs from early stage HCC or without other extrahepatic metastases are occasionally reported [30].…”

“…With best supportive care only, median survival is just around two weeks [12, 20, 31, 33, 53, 54]. Even with treatment, the prognosis for these patients remains poor with a median survival time that ranges from 4 to 12 weeks (Table 1), with mortality due largely to systemic disease progression or metastatic brain disease [17, 33, 35, 52].…”