Natural History of Malignant Bone Disease in Hepatocellular Carcinoma: Final Results of a Multicenter Bone Metastasis Survey

Abstract

BackgroundBone is an uncommon site of metastasis in patients with advanced hepatocellular carcinoma (HCC). Therefore, there are few studies concerning the natural history of bone metastasis in patients with HCC.Patients and MethodsData on clinicopathology, survival, skeletal-related events (SREs), and bone-directed therapies for 211 deceased HCC patients with evidence of bone metastasis were statistically analyzed.ResultsThe median age was 70 years; 172 patients were male (81.5%). The median overall survival was 19 months. The median time to the onset of bone metastasis was 13 months (22.2% at HCC diagnosis); 64.9% patients had multiple bone metastases. Spine was the most common site of bone metastasis (59.7%). Most of these lesions were osteolytic (82.4%); 88.5% of them were treated with zoledronic acid. At multivariate analysis, only the Child Score was significantly correlated with a shorter time to diagnosis of bone metastases (p = 0.001, HR = 1.819). The median survival from bone metastasis was 7 months. At multivariate analysis, HCC etiology (p = 0.005), ECOG performance status (p = 0.002) and treatment with bisphosphonate (p = 0.024) were associated with shorter survival after bone disease occurrence. The site of bone metastasis but not the number of bone lesions was associated with the survival from first skeletal related event (SRE) (p = 0.021) and OS (p = 0.001).ConclusionsThis study provides a significant improvement in the understanding the natural history of skeletal disease in HCC patients. An early and appropriate management of these patients is dramatically needed in order to avoid subsequent worsening of their quality of life.

An Atypical Initial Presentation of Hepatocellular Carcinoma as Spinal Cord Compression

“…In HCC, the most frequently encountered metastatic sites are lungs (47%), lymph nodes (45%), bone (37%), and rarely adrenal glands (12%) [3]. An increased incidence of bone metastases of up to 25% over the last decade involving the axial skeleton frequently has been previously observed [4,5]. While spinal cord compression does occur in patients with advanced HCC, initial presentation of HCC as a spinal cord compression in the setting of HBV is rare [6,7].…”

Establishment of a Disease-Specific Graded Prognostic Assessment for Hepatocellular Carcinoma Patients with Spinal Metastasis

“…Consequently, bone metastases of HCC have become a more frequent occurrence 1,2. Spinal metastasis (SM) occurs in 50% to 75% of cases of bone metastases of HCC and can lead to neurologic deficits and a reduced quality of life 4–8.…”

Bone Metastases of Hepatocellular Carcinoma: Appearance on MRI Using a Standard Abdominal Protocol

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1 are located in the thoracic and lumbar spine [3,[7][8][9], a location that is commonly, at least in part, included in the FOV of a standard abdominal protocol.HCC bone metastases tend to be osteolytic, resulting in significant morbidity for patients from the associated skeletal-related events. Skeletal-related events include pathologic fractures, the requirement for surgery or radiotherapy, spinal cord compression, and, less frequently, malignant hypercalcemia [3].

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“…Skeletal-related events include pathologic fractures, the requirement for surgery or radiotherapy, spinal cord compression, and, less frequently, malignant hypercalcemia [3]. Therefore, early and appropriate management of these patients would be desirable to avoid subsequent worsening of their quality of life [8]. As a result, radiologists should perform an active search for bone metastases in interpreting imaging studies of the liver.…”

“…As a result, radiologists should perform an active search for bone metastases in interpreting imaging studies of the liver. Recognition of their MRI features is important, so they can be identified as early as possible, because their presence will alter the staging and will influence the choice of therapy and management [8].G a s t r oi nt e s t i n a l I m agi ng • O r ig i n a l Re s e a rc h …”