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Clinical and Translational Oncology

, Volume 15, Issue 9, pp 732–740 | Cite as

Defining prognostic factors of survival after external beam radiotherapy treatment of hepatocellular carcinoma with lymph node metastases

  • Y.-X. Chen
  • Z.-C. ZengEmail author
  • J. Fan
  • Z.-Y. Tang
  • J. Zhou
  • M.-S. Zeng
  • J.-Y. Zhang
  • J. Sun
Research Article

Abstract

Purpose

To identify independent predictors of survival in patients with lymph node (LN) metastases from hepatocellular carcinoma (HCC) after external beam radiotherapy (EBRT).

Methods

There were 191 patients with LN metastases from HCC received EBRT enrolled in the study cohort. EBRT was designed to focus on the LNs and a median dose of 50 Gy (range 40–60 Gy) was delivered. Treatment response was assessed by the WHO response criteria. Factors such as demographic data, tumor characteristics, and treatment modalities were determined before EBRT. Predictors of survival were identified by univariate and multivariate analysis.

Results

The median survival was 8.0 months for all patients. Factors including Child-Pugh status (p = 0.009), intrahepatic tumor control (p = 0.015), LN location (p = 0.015), and response to EBRT (p < 0.001) were significant prognostic factors predicting for survival by multivariate analysis. The objective regression rate (ORR), which is the sum of complete and partial response rates, was as high as 79.1 %. As determined by multivariate analysis, the factors of LN location near liver (p = 0.002), smaller LN size (p = 0.021), and higher EBRT dose (p < 0.001) were associated with higher ORR values.

Conclusion

This study provides detailed information about survival outcomes and prognostic factors. Child-Pugh B value, uncontrolled intrahepatic tumor, LN location far from liver, and no response to EBRT are the unfavorable independent predictors.

Keywords

Hepatocellular carcinoma External beam radiotherapy Prognostic Lymph node Metastasis 

Notes

Conflict of interest

No potential conflicts of interest exist.

References

  1. 1.
    El-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750PubMedCrossRefGoogle Scholar
  2. 2.
    Jemal A, Clegg LX, Ward E et al (2004) Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer 101:3–27PubMedCrossRefGoogle Scholar
  3. 3.
    Ho CL, Chen S, Yeung DWC, Cheng TKC (2007) Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma. J Nucl Med 48:902–909PubMedCrossRefGoogle Scholar
  4. 4.
    Natsuizaka M, Omura T, Akaike T et al (2005) Clinical features of hepatocellular carcinoma with extrahepatic metastases. J Gastroenterol Hepatol 20:1781–1787PubMedCrossRefGoogle Scholar
  5. 5.
    Marelli L, Stigliano R, Triantos C et al (2006) Treatment outcomes for hepatocellular carcinoma using chemoembolization in combination with other therapies. Cancer Treat Rev 32:594–606PubMedCrossRefGoogle Scholar
  6. 6.
    Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236PubMedCrossRefGoogle Scholar
  7. 7.
    Sun HC, Zhuang PY, Qin LX et al (2007) Incidence and prognostic values of lymph node metastasis in operable hepatocellular carcinoma and evaluation of routine complete lymphadenectomy. J Surg Oncol 96:37–45PubMedCrossRefGoogle Scholar
  8. 8.
    Uenishi T, Hirohashi K, Shuto T et al (2000) The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma. Surg Today 30:892–895PubMedCrossRefGoogle Scholar
  9. 9.
    Cheng AL, Guan Z, Chen Z et al (2012) Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer 48(10):1452–1465PubMedCrossRefGoogle Scholar
  10. 10.
    Zeng ZC, Tang ZY, Fan J et al (2005) Consideration of the role of radiotherapy for lymph node metastases in patients with HCC—a retrospective analysis for prognostic factors from 125 patients. Int J Radiat Oncol Biol Phys 63:1067–1076PubMedCrossRefGoogle Scholar
  11. 11.
    Yamashita H, Nakagawa K, Shiraishi K et al (2007) Radiotherapy for lymph node metastases in patients with hepatocellular carcinoma: retrospective study. J Gastroenterol Hepatol 22:523–527PubMedCrossRefGoogle Scholar
  12. 12.
    Toya R, Murakami R, Yasunaga T et al (2009) Radiation therapy for lymph node metastases from hepatocellular carcinoma. Hepatogastroenterology 56(90):476–480PubMedGoogle Scholar
  13. 13.
    Kim K, Chie EK, Kim W et al (2010) Absence of symptom and intact liver function are positive prognosticators for patients undergoing radiotherapy for lymph node metastasis from hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 78(3):729–734PubMedCrossRefGoogle Scholar
  14. 14.
    Chinese Liver Cancer Association (2000) The diagnostic criteria and stages of primary hepatoma in the 4th national conference of liver cancer. Problems and discussion. Chin J Gen Surg 15:238–239Google Scholar
  15. 15.
    Miller AB, Hoogstraten B, Staquet M et al (1981) Reporting results of cancer treatment. Cancer 47:207–214PubMedCrossRefGoogle Scholar
  16. 16.
    Cox JD, Stetz J, Pajak TF (1995) Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 31:1341–1346PubMedCrossRefGoogle Scholar
  17. 17.
    Kobayashi S, Takahashi S, Kato Y et al (2011) Surgical treatment of lymph node metastases from hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 18(4):559–566PubMedCrossRefGoogle Scholar
  18. 18.
    Yoon SM, Kim JH, Choi EK et al (2004) Radioresponse of hepatocellular carcinoma—treatment of lymph node metastasis. Cancer Res Treatment 36:79–84CrossRefGoogle Scholar
  19. 19.
    Okuda K, Ohtsuki T, Obata H et al (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment: study of 850 patients. Cancer 56:918–928PubMedCrossRefGoogle Scholar
  20. 20.
    The Cancer of the Liver Italian Program (CLIP) Investigators (1998) A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. Hepatology 28:751–755CrossRefGoogle Scholar
  21. 21.
    Llovet JM, Bru′ C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338PubMedCrossRefGoogle Scholar
  22. 22.
    Park YJ, Lim DH, Paik SW et al (2006) Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma. J Gastroenterol 41:1099–1106PubMedCrossRefGoogle Scholar
  23. 23.
    Liu MT, Li SH, Chu TC et al (2004) Three-dimensional conformal radiation therapy for unresectable hepatocellular carcinoma patients who had failed with or were unsuited for transcatheter arterial chemoembolization. Jpn J Clin Oncol 34:532–539PubMedCrossRefGoogle Scholar
  24. 24.
    Park HC, Seong J, Han KH et al (2002) Dose-response relationship in local radiotherapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 54:150–155PubMedCrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2013

Authors and Affiliations

  • Y.-X. Chen
    • 1
  • Z.-C. Zeng
    • 1
    Email author
  • J. Fan
    • 2
  • Z.-Y. Tang
    • 2
  • J. Zhou
    • 2
  • M.-S. Zeng
    • 3
  • J.-Y. Zhang
    • 1
  • J. Sun
    • 1
  1. 1.Department of Radiation Oncology, Zhongshan HospitalFudan UniversityShanghaiChina
  2. 2.Liver Cancer Institute, Zhongshan HospitalFudan UniversityShanghaiChina
  3. 3.Department of Radiology, Zhongshan HospitalFudan UniversityShanghaiChina

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