title: Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors.
abstract: OBJECTIVE
  The survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and treatment modalities. Consequently, bone metastases from HCC are diagnosed more frequently. We investigated the clinical features, prognosis, treatment outcomes, and prognostic factors of HCC presenting with bone metastasis.
  
  
  METHODS
  Between June 2000 and April 2007, we recruited 37 consecutive HCC patients presenting with bone metastasis. These patients were divided into an untreated control group (n = 16) and a treated group (n = 21).
  
  
  RESULTS
  The mean age of the patients was 61.1 years (male:female, 31:6). The most common cause of HCC was hepatitis B virus infection (56.8%). Twenty-two patients (59.5%) were of Child-Pugh class A and 15 (40.5%) were of Child-Pugh class B. Spinal metastasis was most common and noted in 21 patients (56.7%). The treatment modalities in the treated group included intra-arterial chemotherapy in nine patients (42.8%), systemic chemotherapy in five (23.8%), and both intra-arterial and systemic chemotherapy in seven (33.4%). The median survival of all patients was 6.2 months (range 0.7-46.6); that of untreated control group and the treated group was 2.9 (range 0.7-42.2) and 9.7 (range 0.9-46.6) months, respectively, with no significant difference (log-rank test, P = 0.081). Cox regression analysis revealed that the presence of ascites at the initial presentation was the only prognostic factor (P = 0.016).
  
  
  CONCLUSIONS
  Although our study showed that locoregional and/or systemic chemotherapy did not provide significant survival prolongation compared to supportive care in patients with HCC initially accompanied by bone metastasis, a more large-scaled randomized study might be required.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Hyung Joong
authors.initials: HJ
authors.lastname: Nah
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
mesh_terms: D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000556:secondary*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate