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Prognosis of hepatocellular carcinoma patients with extrahepatic metastasis and the controllability of intrahepatic lesions

Abstract

Although advanced hepatocellular carcinoma (HCC) with extrahepatic metastasis is recommended to be treated by a systemic chemotherapeutic agent without local treatment targeting the liver, studies reported that causes of death in these patients were mostly from progression of intrahepatic lesions. Thus, this study investigated prognosis and factors predicting survival in these patients so as to evaluate the role of local treatments against intrahepatic lesions when the patients already had extrahepatic metastasis. This retrospective study evaluated medical records of 277 patients with HCC and extrahepatic metastasis. The median survival was 5.9 months, and 257 patients died during the follow up. Factors affecting survival of HCC patients with extrahepatic metastasis were poor response to treatment of hepatic lesions (HR 2.207; 95 % CI; p < 0.001), applying local treatment specifically targeting intrahepatic lesions (HR 0.591; 95 % CI 0.436–0.803; p = 0.001), intrahepatic tumor size larger than 3 cm (HR 2.065; 95 % CI 1.444–2.954; p < 0.001), and ECOG performance status 2 or higher (HR 1.543; 95 % CI 1.057–2.253; p = 0.025). The patients with either complete or partial response to the therapy had 1- and 2-year survival rate of 48.8 and 12.1 % whereas patient with either stable or progressive disease had 1-year survival rate of 11.4 %. These results suggest that even in the HCC patients with extrahepatic metastasis, effective local treatment may still be beneficial for the survival especially in patients with acceptable performance status.

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Abbreviations

HCC:

Hepatocellular carcinoma

BCLC:

Barcelona Clinic Liver Cancer

RFA:

Radiofrequency ablation

TACE:

Transarterial chemoembolization

CT:

Computed tomography

MRI:

Magnetic resonance imaging

ECOG:

Eastern Cooperative Oncology Group

(m)RECIST:

(modified) Response evaluation criteria in solid tumors

HR:

Hazard ratio

CI:

Confidence interval

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

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Acknowledgments

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (NRF-2013R1A1A3011912).

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The authors declare that they have no conflict of interest.

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Correspondence to Kwan Sik Lee.

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Lee, J.I., Kim, J.K., Kim, D.Y. et al. Prognosis of hepatocellular carcinoma patients with extrahepatic metastasis and the controllability of intrahepatic lesions. Clin Exp Metastasis 31, 475–482 (2014). https://doi.org/10.1007/s10585-014-9641-x

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  • DOI: https://doi.org/10.1007/s10585-014-9641-x

Keywords

  • Hepatocellular carcinoma
  • Metastasis
  • Survival
  • Treatment