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Hepatocellular carcinoma specific graded prognostic assessment can predict outcomes for patients with brain metastases from hepatocellular carcinoma

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Abstract

Stratifying patients with brain metastasis (BM) from hepatocellular carcinoma (HCC) by prognostic factors can be useful when making treatment decisions. Nevertheless, a diagnosis-specific graded prognostic assessment (GPA) for HCC has not been well established. We retrospectively reviewed the data from 118 HCC patients newly diagnosed with BM at the Yonsei University Health System between 1985 and 2011. After univariate and multivariate analyses of prognostic factors, those shown to significantly affect survival were used to develop a HCC-specific GPA (HCC-GPA) index. The median overall survival after BM in all patients was 6.1 weeks (95 % confidence interval 4.8–7.4 weeks). Using the prognostic factors identified via multivariate analysis, we developed a HCC-GPA index, including number of brain metastases (single: 0.5, multiple: 0 points), alpha-feto protein (<400 ng/mL: 0.5, ≥400 ng/mL: 0 points), and Child-Pugh-Score (A: 3, B: 2, C: 0 points). There were no survival differences for age, sex, performance status, and time interval from initial diagnosis to development of BM. Median survival times from BM were discriminable when applying the HCC-GPA scoring system: 1.7, 3.2, 7.9, and 27.0 weeks for HCC-GPA scores of 0–1.0 (N = 16), 1.5–2.5 (N = 32), 3.0–3.5 (N = 49), and 4.0 (N = 21), respectively (P < 0.001). Although the prognoses of patients with BM from HCC are dismal, the newly developed HCC-GPA index can be used to discriminate the expected prognoses thereof. Moreover, the index may hold value as a tool for selecting patients who may be good candidates for active local treatment.

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References

  1. Chen SF, Tsai NW, Lui CC, Lu CH, Huang CR, Chuang YC, Cheng YF, Kuo CH, Chang WN (2007) Hepatocellular carcinoma presenting as nervous system involvement. Eur J Neurol 14:408–412

    Article  PubMed  Google Scholar 

  2. Choi HJ, Cho BC, Sohn JH, Shin SJ, Kim SH, Kim JH, Yoo NC (2009) Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC. J Neurooncol 91:307–313

    Article  PubMed  Google Scholar 

  3. Kim M, Na DL, Park SH, Jeon BS, Roh JK (1998) Nervous system involvement by metastatic hepatocellular carcinoma. J Neurooncol 36:85–90

    Article  PubMed  CAS  Google Scholar 

  4. Murakami K, Nawano S, Moriyama N, Sekiguchi R, Satake M, Fujimoto H, Ichikawa T (1996) Intracranial metastases of hepatocellular carcinoma: CT and MRI. Neuroradiology 38(Suppl 1):S31–S35

    Article  PubMed  Google Scholar 

  5. Jiang XB, Ke C, Zhang GH, Zhang XH, Sai K, Chen ZP, Mou YG (2012) Brain metastases from hepatocellular carcinoma: clinical features and prognostic factors. BMC Cancer 12:49

    Article  PubMed  PubMed Central  Google Scholar 

  6. Shao YY, Lu LC, Cheng AL, Hsu CH (2011) Increasing incidence of brain metastasis in patients with advanced hepatocellular carcinoma in the era of antiangiogenic targeted therapy. Oncologist 16:82–86

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cheng AL et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34

    Article  PubMed  CAS  Google Scholar 

  8. Llovet JM et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390

    Article  PubMed  CAS  Google Scholar 

  9. Chang L, Chen YL, Kao MC (2004) Intracranial metastasis of hepatocellular carcinoma: review of 45 cases. Surg Neurol 62:172–177

    Article  PubMed  Google Scholar 

  10. Hsieh MJ, Lu CH, Tsai NW, Lui CC, Chuang YC, Huang CR, Chen SF, Chang CC, Chang HW, Chang WN (2009) Prediction, clinical characteristics and prognosis of intracerebral hemorrhage in hepatocellular carcinoma patients with intracerebral metastasis. J Clin Neurosci 16:394–398

    Article  PubMed  Google Scholar 

  11. Yen FS, Wu JC, Lai CR, Sheng WY, Kuo BI, Chen TZ, Tsay SH, Lee SD (1995) Clinical and radiological pictures of hepatocellular carcinoma with intracranial metastasis. J Gastroenterol Hepatol 10:413–418

    Article  PubMed  CAS  Google Scholar 

  12. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751

    Article  PubMed  CAS  Google Scholar 

  13. Gaspar LE, Scott C, Murray K, Curran W (2000) Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys 47:1001–1006

    Article  PubMed  CAS  Google Scholar 

  14. Andrews DW et al (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363:1665–1672

    Article  PubMed  Google Scholar 

  15. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514

    Article  PubMed  Google Scholar 

  16. Sperduto CM, Watanabe Y, Mullan J, Hood T, Dyste G, Watts C, Bender GP, Sperduto P (2008) A validation study of a new prognostic index for patients with brain metastases: the graded prognostic assessment. J Neurosurg 109(Suppl):87–89

    PubMed  Google Scholar 

  17. Sperduto PW et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77:655–661

    Article  PubMed  Google Scholar 

  18. Sperduto PW et al (2012) Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys 82:2111–2117

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sperduto PW et al (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425

    Article  PubMed  PubMed Central  Google Scholar 

  20. Clayton AJ et al (2004) Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer. Br J Cancer 91:639–643

    PubMed  CAS  PubMed Central  Google Scholar 

  21. Sundermeyer ML, Meropol NJ, Rogatko A, Wang H, Cohen SJ (2005) Changing patterns of bone and brain metastases in patients with colorectal cancer. Clin Colorectal Cancer 5:108–113

    Article  PubMed  Google Scholar 

  22. Weil RJ, Palmieri DC, Bronder JL, Stark AM, Steeg PS (2005) Breast cancer metastasis to the central nervous system. Am J Pathol 167:913–920

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Chen AM, Jahan TM, Jablons DM, Garcia J, Larson DA (2007) Risk of cerebral metastases and neurological death after pathological complete response to neoadjuvant therapy for locally advanced nonsmall-cell lung cancer: clinical implications for the subsequent management of the brain. Cancer 109:1668–1675

    Article  PubMed  Google Scholar 

  24. Paez-Ribes M, Allen E, Hudock J, Takeda T, Okuyama H, Vinals F, Inoue M, Bergers G, Hanahan D, Casanovas O (2009) Antiangiogenic therapy elicits malignant progression of tumors to increased local invasion and distant metastasis. Cancer Cell 15:220–231

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  25. Ebos JM, Lee CR, Cruz-Munoz W, Bjarnason GA, Christensen JG, Kerbel RS (2009) Accelerated metastasis after short-term treatment with a potent inhibitor of tumor angiogenesis. Cancer Cell 15:232–239

    Article  PubMed  CAS  Google Scholar 

  26. Matsumoto Y, Suzuki T, Asada I, Ozawa K, Tobe T, Honjo I (1982) Clinical classification of hepatoma in Japan according to serial changes in serum alpha-fetoprotein levels. Cancer 49:354–360

    Article  PubMed  CAS  Google Scholar 

  27. Kim HS, Park JW, Jang JS, Kim HJ, Shin WG, Kim KH, Lee JH, Kim HY, Jang MK (2009) Prognostic values of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II in hepatitis B virus-related hepatocellular carcinoma: a prospective study. J Clin Gastroenterol 43:482–488

    Article  PubMed  CAS  Google Scholar 

  28. Xu HX, Lu MD, Xie XY, Yin XY, Kuang M, Chen JW, Xu ZF, Liu GJ (2005) Prognostic factors for long-term outcome after percutaneous thermal ablation for hepatocellular carcinoma: a survival analysis of 137 consecutive patients. Clin Radiol 60:1018–1025

    Article  PubMed  Google Scholar 

  29. Ueno S, Tanabe G, Nuruki K, Oketani M, Komorizono Y, Hokotate H, Fukukura Y, Baba Y, Imamura Y, Aikou T (2002) Prognosis of hepatocellular carcinoma associated with Child class B and C cirrhosis in relation to treatment: a multivariate analysis of 411 patients at a single center. J Hepatobiliary Pancreat Surg 9:469–477

    Article  PubMed  Google Scholar 

  30. Kwak MS, Lee JH, Yoon JH, Yu SJ, Cho EJ, Jang ES, Kim YJ, Lee HS (2012) Risk factors, clinical features, and prognosis of the hepatocellular carcinoma with peritoneal metastasis. Dig Dis Sci 57:813–819

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Konyang University Hospital, Daejon, Korea

    Seungtaek Lim

  2. Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Korea

    Soohyeon Lee, Ji Soo Park & Hye Jin Choi

  3. Department of Medical Oncology, Gangnam Severance Cancer Hospital, Yonsei University College of Medicine, Seoul, Korea

    Jae Yun Lim

  4. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea

    Jin Sil Seong

  5. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Won Seok Chang

  6. Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

    Kwang-Hyub Han

  7. Severance Hospital Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea

    Jin Sil Seong, Kwang-Hyub Han & Hye Jin Choi

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  1. Seungtaek Lim
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  2. Soohyeon Lee
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  3. Jae Yun Lim
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  4. Ji Soo Park
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  8. Hye Jin Choi
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Correspondence to Hye Jin Choi.

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Lim, S., Lee, S., Lim, J.Y. et al. Hepatocellular carcinoma specific graded prognostic assessment can predict outcomes for patients with brain metastases from hepatocellular carcinoma. J Neurooncol 120, 199–207 (2014). https://doi.org/10.1007/s11060-014-1546-7

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  • DOI: https://doi.org/10.1007/s11060-014-1546-7

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