title: Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma.
abstract: OBJECTIVE
  To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients.
  
  
  METHODS
  After the diagnosis of HCC, all 995 consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features, prognosis, and treatment strategies.
  
  
  RESULTS
  The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure.
  
  
  CONCLUSIONS
  The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly, treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatic tumor stage (T0-T2), and are free of portal venous invasion may improve survival.
authors.affiliation: Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. kiminori@hiroshima-u.ac.jp
authors.forename: Kiminori
authors.initials: K
authors.lastname: Uka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Shintaro
authors.initials: S
authors.lastname: Takaki
authors.forename: Hiroo
authors.initials: H
authors.lastname: Shirakawa
authors.forename: Soo-Cheol
authors.initials: SC
authors.lastname: Jeong
authors.forename: Keitaro
authors.initials: K
authors.lastname: Yamashina
authors.forename: Akira
authors.initials: A
authors.lastname: Hiramatsu
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kodama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies