title: Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors.
abstract: BACKGROUND
  Despite significant advances in the treatment of intrahepatic lesions, the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. The objective of this study was to further elucidate the clinical course and prognostic determinants of patients with this disease.
  
  
  METHODS
  In total, 342 patients who had HCC with extrahepatic metastasis were enrolled. The metastases were diagnosed at initial presentation with HCC in 28 patients and during follow-up in the remaining patients. The authors analyzed clinical features, prognoses, and treatments and established a scoring system to predict prognosis using a split-sample method with a testing set and a training set.
  
  
  RESULTS
  The most frequent site of extrahepatic metastasis was the lung followed by lymph nodes, bone, and adrenal glands. These metastases were related directly to death in only 23 patients (7.6%). The median survival after diagnosis of extrahepatic metastasis was 8.1 months (range, 0.03-108.7 months). In univariate analysis of the training set (n = 171), performance status, Child-Pugh classification, the number and size of intrahepatic lesions, macroscopic vascular invasion, symptomatic extrahepatic metastases, α-fetoprotein levels, and complete responses to treatment were associated significantly with prognosis. On the basis of multivariate analysis, a scoring system was developed to predict prognosis that assessed uncontrollable intrahepatic lesions, extent of vascular invasion, and performance status. This scoring system was validated in the testing set (n = 171) and produced a concordance index of 0.73.
  
  
  CONCLUSIONS
  The controllability of intrahepatic lesions and performance status were identified as important prognostic factors in patients with advanced HCC who had extrahepatic metastasis.
authors: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Koji
authors: K
authors: Uchino
authors: Ryosuke
authors: R
authors: Tateishi
authors: Shuichiro
authors: S
authors: Shiina
authors: Miho
authors: M
authors: Kanda
authors: Ryota
authors: R
authors: Masuzaki
authors: Yuji
authors: Y
authors: Kondo
authors: Tadashi
authors: T
authors: Goto
authors: Masao
authors: M
authors: Omata
authors: Haruhiko
authors: H
authors: Yoshida
authors: Kazuhiko
authors: K
authors: Koike
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000556:secondary* / Q000628:therapy; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy; D001918:Brachytherapy; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms / Q000556:secondary* / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate