title: Importance of achieving complete necrosis during the first treatment for hepatocellular carcinoma to prevent bone metastasis: a prospective study.
abstract: OBJECTIVE
  Recent advances in the treatment of hepatocellular carcinoma (HCC) have changed the importance of bone metastasis during the follow up of such patients. In the present study, we investigated risk factors for bone metastasis after treatment for HCC.
  
  
  METHODS
  Two hundred and two patients with HCC were diagnosed as free of bone metastasis by technecium 99m-methylene diphosphonate bone scintigraphy and were followed prospectively after treatment of the primary lesions (follow-up period 2-146 months; median 20 months). We statistically analyzed the risk factors for bone metastasis using the clinical characteristics at the time of first treatment.
  
  
  RESULTS
  Multiple tumors (P < 0.005), main tumor size > 5 cm in diameter (P < 0.005), the presence of distant metastasis (P < 0.005), elevation of serum alpha-fetoprotein (> 100 ng/mL; P < 0.05), chemotherapy (P < 0.05) and insufficient therapeutic response (P < 0.0005) were identified as risk factors for bone metastasis by univariate analyses. Insufficient therapeutic response and main tumor size > 5 cm in diameter (both P < 0.05) were identified as independent predisposing factors for bone metastasis.
  
  
  CONCLUSIONS
  Complete necrosis of primary HCC during the first treatment is important to prevent subsequent bone metastasis.
authors.affiliation: First Department of Internal Medicine, Kanazawa University School of Medicine, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Iwata
authors.forename: S
authors.initials: S
authors.lastname: Kaneko
authors.forename: S
authors.initials: S
authors.lastname: Terasaki
authors.forename: E
authors.initials: E
authors.lastname: Matsushita
authors.forename: T
authors.initials: T
authors.lastname: Urabe
authors.forename: K
authors.initials: K
authors.lastname: Kobayashi
authors.forename: O
authors.initials: O
authors.lastname: Matsui
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D009336:Necrosis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012307:Risk Factors; D016019:Survival Analysis