title: Clinical features of hepatocellular carcinoma with extrahepatic metastases.
abstract: BACKGROUND
  There are few detailed clinical reports about extrahepatic metastases of hepatocellular carcinoma (HCC). The purpose of the present study was to elucidate the clinical features of extrahepatic metastases of HCC.
  
  
  METHODS
  The clinical records of 482 patients who had been diagnosed as having HCC during the period from January 1995 to March 2001 were retrospectively reviewed. Extrahepatic metastases had been detected in 65 patients. Clinical features of those 65 patients were analyzed.
  
  
  RESULTS
  Patients with extrahepatic metastases had more advanced intrahepatic tumors at the first diagnosis of HCC: 73.8% of the patients with extrahepatic metastases had tumors of intrahepatic tumor stage T3 or T4 according to the TNM classification, while only 28.5% of the patients without extrahepatic metastases had tumors of T3 or T4 (P < 0.001). Vessel invasion was also detected at the first diagnosis of HCC more frequently in the patients with extrahepatic metastasis (P < 0.001). The frequent metastatic sites were lung (53.8%), bone (38.5%), and lymph node (33.8%). Other metastatic sites were the adrenal gland, peritoneum, skin, brain and muscle. The median survival time and 1-year survival rate were 7 months (range: 1-59 months) and 24.9%, respectively. Patients with Child-Pugh grade B and C (P = 0.0018) and patients with positive serum alpha-fetoprotein (P = 0.011) had significantly poor prognosis.
  
  
  CONCLUSIONS
  Extrahepatic metastases of HCC are not rare. The possibility of extrahepatic metastases and the clinical features of extrahepatic metastases should be considered when examining patients with HCC, particularly those with advanced intrahepatic tumors, to enable precise evaluation of the spread of HCC and determination of the appropriate treatment method.
authors.affiliation: Gastroenterology and Hematology Section, Department of Internal Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. natsu-m@med.hokudai.ac.jp
authors.forename: Mitsuteru
authors.initials: M
authors.lastname: Natsuizaka
authors.forename: Takumi
authors.initials: T
authors.lastname: Omura
authors.forename: Toru
authors.initials: T
authors.lastname: Akaike
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kuwata
authors.forename: Katsu
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sato
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Karino
authors.forename: Jouji
authors.initials: J
authors.lastname: Toyota
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Suga
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000556:secondary* / Q000628:therapy / Q000821:virology; D018450:Disease Progression; D005260:Female; D006525:Hepatitis, Viral, Human; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy / Q000821:virology; D008175:Lung Neoplasms / Q000150:complications / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies