Natural disease progression and novel survival prediction model for hepatocellular carcinoma with spinal metastases: a 10-year single-center study

Abstract

Background: Individual prediction of life expectancy in patients with spinal metastases from hepatocellular carcinoma (HCC) is key for optimal treatment selection, especially when identifying potential candidates for surgery. Most reported prognostic tools provide categorical predictions, and only a few include HCC-related factors. This study aimed to investigate the natural progression of the disease and develop a prognostic tool that is capable of providing individualized predictions. Methods: Patients with HCC-derived metastatic spinal disease were identified from a retrospective cohort of patients with spinal metastases who were diagnosed at Chiang Mai University Hospital between 2006 and 2015. Kaplain-Meier methods and log-rank tests were used to statistically evaluate potential factors. Significant predictors from the univariable analysis were included in the flexible parametric survival regression for the development of a prognostic prediction model. Results: Of the 1143 patients diagnosed with HCC, 69 (6%) had spinal metastases. The median survival time of patients with HCC after spinal metastases was 79 days. In the multivariable analysis, a total of 11 potential clinical predictors were included. After backward elimination, four final predictors remained: patients aged > 60 years, Karnofsky Performance Status, total bilirubin level, and multifocality of HCC. The model showed an acceptable discrimination at C-statistics 0.73 (95% confidence interval 0.68-0.79) and fair calibration. Conclusion: Four clinical parameters were used in the development of the individual survival prediction model for patients with HCC-derived spinal metastases of Chiang Mai University or HCC-SM CMU model. Prospective external validation studies in a larger population are required prior to the clinical implication of the model.

Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma

“…In our data, which were obtained from a tertiary care hospital, only 14.7% were given HCC-specific treatment. Only 3% underwent surgical intervention, which was even lower than the figure reported in the nearby University hospital (7%) [43]. In this situation, where most patients have incurable disease with progressive symptoms, integration of palliative care with standard oncologic treatment is appealing.…”

Epidemiological and pathological characteristics of spinal metastases from gastrointestinal cancers – a series of 40 cases

“…Spinal metastases starting from hepatocarcinomas are rare, with articles published to date reporting an incidence varying between 0.2% and 6% [ 41 ].…”

“…This type of metastases can be located in any of the regions of the spine, as follows: one-third is located in combined regions of the spine, another third in the thoracic region, a quarter of cases in the lumbar region, and less than 10% are identified in the cervical region [ 41 , 42 ].…”

A Cancer-Pain Analgesia as Prolonging Strategy of Surviving Time after Failure of Adjuvant Chemotherapy in Patient with Progressive Bone-Metastatic Hepatocellular Carcinoma

“…Another single-center study analyzed 1,143 patients with HCC and 69 of all (6%) had bone metastases. They concluded that an average ST in patients with bone metastases was 79 days and that four predictors of prognosis exist: age >60 years, poor Karnofsky Performance Status (vs. good and moderate), serum total bilirubin >3.0 mg/dL, and multifocality of HCC (vs. single tumor) [ 4 ]. In the other analysis, patients who have failed downstaging of metastatic HCC can achieve better prognosis than those without neoadjuvant therapy (median overall survival: 10.3 months vs. 4.0 months) [ 5 ].…”