Prognostic analysis of pulmonary metastases from hepatocellular carcinoma

Abstract

Purpose To analyze the prognostic factors for the patients with lung metastases from hepatocellular carcinoma (HCC). Methods and materials One hundred and five patients with lung metastases from HCC were analyzed retrospectively. We analyzed the impact factors, including the gender, age, liver function, serum AFP and c-GT level, the status of intrahepatic tumor and pulmonary metastases and treatment for them, the distant metastases beyond the lung, as well as the causes of death. The overall cumulative probability of survival was calculated by the Kaplan-Meier method, and the difference between the groups was compared using the Log-rank test. Univariate and multivariate analyses using the Cox-regression proportional hazard model were performed to evaluate the prognostic parameters for survival. Result The survival after the lung metastases was influenced by clinical parameters, such as the status and the treatment for both the intrahepatic tumor and the pulmonary lesions. The causes of death were respiratory failure due to metastatic lesions from HCC in 16 patients (20.0%), liver failure caused by the progressive intrahepatic lesions in 54 (67.5%). The mean and median survival times were 684 and 487 days after HCC diagnosis and 264 and 179 days after lung metastases, respectively. Conclusion It was very important to treat the intrahepatic tumor because its worsening was still the major cause of death. The progressive treatment for pulmonary metastases may also be advised for possible prolongation of survival.

The impact of hospice care on survival and cost saving among patients with liver cancer: a national longitudinal population-based study in Taiwan

“…This study found the mean survival after the date of diagnosis in hospice and non-hospice group to be 1.77±2.44 and 1.84±2.37 years, respectively, a result similar to that reported for liver cancer patients by Zhang et al (1.87±0.19 years) [21] and for lung cancer patients by Saito et al [7]. Considering these findings together, it is clear that hospice care does no hasten death and this notion should not be used as a barrier to hospice service.…”

Palliative radiation therapy for pulmonary metastases from hepatocellular carcinoma

“…Although only three patients had died at the end of follow-up, lack of control of the intrahepatic lesions remains the major problem. The survival time of these 13 selected patients with controlled intrahepatic lesions was longer than that previously reported by us [11]. Thus, it is important to treat the intrahepatic lesions appropriately after EBRT for lung lesions.…”

“…The 13 patients had a long survival in spite of lung metastasis. Although a control group was not formally defined (e.g., by a less efficacious standard treatment protocol), reviewing and comparing our results to those of previous studies on the same type of patients who were treated by other methods does give a relative context within which we can draw some conclusions [10,11]. The higher OS in our study might be explained by selection of patients with less aggressive tumors, even though there was a relatively long interval between the diagnosis of pulmonary metastases and EBRT.…”

“…Thus, it is important to treat the intrahepatic lesions appropriately after EBRT for lung lesions. On the other hand, we conclude that EBRT is an effective treatment to alleviate symptoms and improve local control in the estimated 20.0% of patients who die from respiratory failure due to metastatic lesions [11]. We attempted to deliver 50-60 Gy to lung lesions according to the individual status of the lesions, the degree of local control of intrahepatic tumors, and the limitation of V 20 .…”

Radiation therapy for hepatocellular carcinoma: current status and perspectives from our experience

“…The lung is the most common site of extrahepatic metastases of HCC; but only 20% of deaths were caused by lung metastases in HCC patients because most pulmonary metastases of HCC are multiple and progress more slowly than intrahepatic lesions [11]. It is difficult to perform dose distribution satisfactorily in conformal or intensitymodulated RT using a traditional accelerator.…”