Prevalence of metastases in hepatocellular carcinoma: risk factors and impact on survival.
The purpose of this study was to determine the prevalence and risk factors of metastases in hepatocellular carcinoma (HCC) patients and analyze the effects of different locations of metastases on survival. Retrospective analysis was performed on 347 HCC patients who received a metastatic workup including bone scan and computed tomography scans of chest, abdomen, and pelvis. Clinical and tumor characteristics were evaluated as risk factors for metastasis by univariate and multivariate methods. Survival was analyzed by Kaplan-Meier and Cox regression methods. One hundred forty-five patients had metastases: 72 had thoracic, 57 had abdominal, and 34 had bone metastases. Significant differences were noted with weight loss, hepatitis C, tumor grade, tumor multifocality, size, and alkaline phosphatase levels between the metastases group and the nonmetastases group by univariate analysis. Poor differentiation, multilobar spread, and size (> or = 5 cm) were strongest predictors of metastatic disease by logistic regression. Patients with thoracic metastases had significantly poorer survival. HCC metastasis is prevalent on initial presentation. Evaluation for liver transplantation or curative resection requires a full metastatic workup. Poor differentiation, larger tumors, and those with multilobar spread have increased risk for metastasis. Patients with thoracic spread have poor prognosis as compared to other locations of metastasis.
UCI Medical Center, Department of Surgery, Section of Hepatobiliary and Pancreas Surgery and Islet Cell Transplantation, Orange, California 92868, USA.
Ming-Sing
MS
Si
Farin
F
Amersi
S Raymond
SR
Golish
Jorge A
JA
Ortiz
Joseph
J
Zaky
Debbie
D
Finklestein
Ronald W
RW
Busuttil
David K
DK
Imagawa
D000008:Abdominal Neoplasms / Q000401:mortality / Q000556:secondary; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality / Q000556:secondary*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000401:mortality / Q000556:secondary; D013997:Time Factors; D015431:Weight Loss