Hepatocellular carcinoma with extrahepatic metastasis

Abstract

BACKGROUND: Despite significant advances in the treatment of intrahepatic lesions, the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. The objective of this study was to further elucidate the clinical course and prognostic determinants of patients with this disease. METHODS: In total, 342 patients who had HCC with extrahepatic metastasis were enrolled. The metastases were diagnosed at initial presentation with HCC in 28 patients and during follow-up in the remaining patients. The authors analyzed clinical features, prognoses, and treatments and established a scoring system to predict prognosis using a split-sample method with a testing set and a training set. RESULTS: The most frequent site of extrahepatic metastasis was the lung followed by lymph nodes, bone, and adrenal glands. These metastases were related directly to death in only 23 patients (7.6%). The median survival after diagnosis of extrahepatic metastasis was 8.1 months (range, 0.03-108.7 months). In univariate analysis of the training set (n ¼ 171), performance status, Child-Pugh classification, the number and size of intrahepatic lesions, macroscopic vascular invasion, symptomatic extrahepatic metastases, a-fetoprotein levels, and complete responses to treatment were associated significantly with prognosis. On the basis of multivariate analysis, a scoring system was developed to predict prognosis that assessed uncontrollable intrahepatic lesions, extent of vascular invasion, and performance status. This scoring system was validated in the testing set (n ¼ 171) and produced a concordance index of 0.73. CONCLUSIONS: The controllability of intrahepatic lesions and performance status were identified as important prognostic factors in patients with advanced HCC who had extrahepatic metastasis. Cancer 2011;117:4475-

The systemic inflammatory response as a prognostic factor for advanced hepatocellular carcinoma with extrahepatic metastasis

“…As regards clinical characteristics, including main site of metastasis and survival, our results were similar to those of previous reports (17)(18)(19)(20)(21)(22). The analysis of prognosis revealed that the degree of intrahepatic tumor progression (T stage), hepatic functional reserve (Child-Pugh class) and tumor marker levels (AFP) were all significant prognostic factors, as previously reported (19,21,22).…”

“…It has been reported that common sites of extrahepatic metastasis that are clinically characteristic for this stage of HCC in patients aged >50 years include the lungs (39.5-67.3%), followed by the lymph nodes (27.9-45.0%) and bone (18.3-35.8%) (17)(18)(19)(20)(21)(22). As regards prognosis, the MST has been reported to be 4.9-8.1 months (19,20,22) whereas survival analyses indicate that the state of the intrahepatic tumor, Child-Pugh class and tumor markers are independent prognostic factors of survival (19,20,23). The analysis of stage IVB HCC prognosis indicates that there are more deaths from intrahepatic events rather than from extrahepatic events, and the degree of intrahepatic tumor progression is a significant risk factor (20).…”

“…As regards prognosis, the MST has been reported to be 4.9-8.1 months (19,20,22) whereas survival analyses indicate that the state of the intrahepatic tumor, Child-Pugh class and tumor markers are independent prognostic factors of survival (19,20,23). The analysis of stage IVB HCC prognosis indicates that there are more deaths from intrahepatic events rather than from extrahepatic events, and the degree of intrahepatic tumor progression is a significant risk factor (20). Furthermore, it has been reported that AFP is a marker of tumor progression (22), and that total bilirubin, Alb and Child-Pugh class are indices of hepatic functional reserve (19,22,24).…”

Clinical characteristics and prognostic factors for advanced hepatocellular carcinoma with extrahepatic metastasis

“…A possible explanation for this lack of difference is that worse liver function and an increased malignant potential of previously treated patients may offset the more advanced stage of intrahepatic tumors of previously untreated patients. The major sites of HCC metastasis included the lungs, lymph nodes, bones and adrenal glands (13,14,(19)(20)(21). Yoo et al (20) reported that the most frequent metastatic sites in 251 previously untreated HCC patients with extrahepatic metastasis were the lungs (67.3%), lymph nodes (37.5%), bones (18.3%) and adrenal glands (7.6%).…”

“…As regards patients with advanced HCC with extrahepatic metastasis, several previous studies only reported the clinicopathological characteristics and prognosis of patients with HCC recurrence or a combined set of previously treated and untreated patients (11)(12)(13)(14) …”