Prognostic scoring system for metastatic spine tumors derived from hepatocellular carcinoma

Abstract

Purpose: The prognosis of hepatocellular carcinoma (HCC) has recently improved, and so clinicians have greater opportunity to treat HCC-derived spinal metastases. Therefore, predicting life expectancy is important for determining the optimal treatment strategy for such tumors. This study aimed to investigate the prognostic factors for HCC-derived metastatic spine tumors and to develop a scoring system for predicting life expectancy in such cases. Methods: The posttreatment survival time and factors that might influence it were investigated in 62 patients with HCC-derived metastatic spine tumors who were treated at our department (surgery: 27 patients and conservative treatment: 35 patients), and a prognostic scoring system for predicting life expectancy was developed by combining the factors that significantly influenced survival. Results: In the univariate analyses, sex, the patient's general condition, the presence/ absence of major internal organ metastasis, the total revised Tokuhashi score, the serum albumin level, Child-Pugh class, spinal surgery, and bone-modifying agent (BMA) treatment were found to influence the posttreatment survival time. These factors were subjected to multivariate analysis, and a novel scoring system for predicting life expectancy based on the patient's general condition, the serum albumin level (or Child-Pugh class), and BMA treatment was developed. In the retrospective analysis, the concordance rate between the patients' life expectancy and actual survival times was 90.3%. Conclusion: The patient's general condition, the serum albumin level (or Child-Pugh class), and BMA treatment influenced the posttreatment survival times of patients with HCC-derived metastatic spine tumors. A prognostic scoring system based on these factors was proposed.

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

“…From our 10year study, only six percent of patients with HCC were found to have spinal metastases with a median survival time of 79 days, which was relatively short compared with that of other common metastatic tumor to the spine such as lung cancer (11.3 months) [12], breast cancer (21.7 months) [13], prostate cancer (58.3 months for hormone naïve and 5 months for hormone refractory [14,15]), thyroid cancer (15.4 months) [16], and cholangiocarcinoma (3 months) [17]. In comparison with other reports on the survival of patients with HCC-derived spinal metastasis [6,18,19], the median survival time after metastasis was also shorter in our study. This could be explained by the lower rate of primary surgical resection and higher rate of palliative treatment and best supportive care in our study.…”

“…Interestingly, most of these factors were either patient-related (i.e., Eastern Cooperative Oncology Group or ECOG and KPS) [6,[20][21][22], liver-related (i.e., serum albumin level, serum lactate dehydrogenase or LDH, and Child-Pugh classi cation) [6,21,23,24], or metastatic-related (visceral metastasis, other extrahepatic metastasis other than bone metastases) characteristics [22][23][24][25]. For tumor-related or intervention-related factors, primary HCC control or response to HCC treatment (i.e., response to radiotherapy, previous resection of primary HCC) were reported to be associated with patient survival after the diagnosis of spinal metastases [6,20,22,24]. Previous scoring systems (i.e., Tomita score and Revised Tokuhashi score) have also been reported to be capable of survival prediction in this domain of patients [5,23,26].…”

“…Our study is the rst one to demonstrate the effect of old age (> 60 years) on the survival of patients with HCC-derived spinal metastases. The patient's performance status, either via ECOG or KPS, was consistently identi ed as an in uential survival factor in HCC patients with spinal metastases [6,23] and were included as predictors in two recently developed prediction models: HCC-SM GPA by Rim et al [24] and another scoring system by Uei and Tokuhashi [6].…”

“…For liver-related factors, only serum total bilirubin was found to be an independent survival predictor in our patient cohort. Serum bilirubin had never been independently explored as a prognostic factor in HCCderived spinal metastasis, as all previous studies only examined the effect of serum albumin level or Child-Pugh classi cation as a whole [6,21,23,24]. In our analysis, we separated the component of Child-Pugh classi cation to examine their independent effect on patient survival.…”

“…Individual prognosis of survival after the diagnosis of spinal metastases is therefore crucial to aid clinicians to determine the optimal management for each speci c HCC patient [5]. A life expectancy of more than six months is generally considered the ideal cutoff point for surgical management of the patient [6]. In the past, several series of prognostic factors and scoring systems were used in combination to predict patient survival.…”