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Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors

  • Seung Up Kim
  • Do Young Kim
  • Jun Yong Park
  • Sang Hoon Ahn
  • Hyung Joong Nah
  • Chae Yoon Chon
  • Kwang-Hyub Han
Original Paper

Abstract

Purpose

The survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and treatment modalities. Consequently, bone metastases from HCC are diagnosed more frequently. We investigated the clinical features, prognosis, treatment outcomes, and prognostic factors of HCC presenting with bone metastasis.

Methods

Between June 2000 and April 2007, we recruited 37 consecutive HCC patients presenting with bone metastasis. These patients were divided into an untreated control group (n = 16) and a treated group (n = 21).

Results

The mean age of the patients was 61.1 years (male:female, 31:6). The most common cause of HCC was hepatitis B virus infection (56.8%). Twenty-two patients (59.5%) were of Child-Pugh class A and 15 (40.5%) were of Child-Pugh class B. Spinal metastasis was most common and noted in 21 patients (56.7%). The treatment modalities in the treated group included intra-arterial chemotherapy in nine patients (42.8%), systemic chemotherapy in five (23.8%), and both intra-arterial and systemic chemotherapy in seven (33.4%). The median survival of all patients was 6.2 months (range 0.7–46.6); that of untreated control group and the treated group was 2.9 (range 0.7–42.2) and 9.7 (range 0.9–46.6) months, respectively, with no significant difference (log-rank test, = 0.081). Cox regression analysis revealed that the presence of ascites at the initial presentation was the only prognostic factor (= 0.016).

Conclusion

Although our study showed that locoregional and/or systemic chemotherapy did not provide significant survival prolongation compared to supportive care in patients with HCC initially accompanied by bone metastasis, a more large-scaled randomized study might be required.

Keywords

Bone metastasis Hepatocellular carcinoma Prognosis Survival Treatment outcome Prognostic factors 

Notes

Acknowledgments

This study was supported by the grant of the Good Health R&D Project from the Ministry of Health and Welfare, Republic of Korea (A050021), and in part by the grant from Brain Korea 21 Project for Medical Science. The author thanks Mooyoung Han, Ph.D. (Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea) for critical comments on statistics.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Seung Up Kim
    • 1
    • 2
  • Do Young Kim
    • 1
    • 2
  • Jun Yong Park
    • 1
    • 2
  • Sang Hoon Ahn
    • 1
    • 2
  • Hyung Joong Nah
    • 3
  • Chae Yoon Chon
    • 1
    • 2
  • Kwang-Hyub Han
    • 1
    • 2
  1. 1.Department of Internal MedicineInstitute of Gastroenterology, Yonsei University College of MedicineSeoulSouth Korea
  2. 2.Liver Cirrhosis Clinical Research CenterSeoulSouth Korea
  3. 3.Department of Internal MedicineNational Health Insurance Corporation Ilsan HospitalGoyangSouth Korea

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