title: Extrahepatic metastases occur in a minority of hepatocellular carcinoma patients treated with locoregional therapies: analyzing patterns of progression in 285 patients.
abstract: Although most cancers are considered predominantly systemic processes, this may not hold true for hepatocellular carcinoma (HCC). The literature regarding patterns of progression of HCC (local versus systemic) has been relatively sparse. Our objectives were to: (1) analyze patterns of progression in HCC patients presenting with intrahepatic disease from initial treatment until death, and (2) identify clinically relevant risk factors for the development of metastases. Over a 9-year period, 285 patients treated with transarterial locoregional therapies underwent scheduled imaging follow-up from treatment until death and were categorized by pattern of progression: (i) intrahepatic (increased tumor enhancement/size, development/progression of vascular invasion, new hepatic lesions) progression or (ii) extrahepatic (adrenal/bone/lung/lymph node) metastases. Uni/multivariate analyses assessing the risk factors for the development of metastases were performed. The median time from last scan to death was 2.4 months (interquartile range: 1.3-4.8 months). The time to development of metastases, vascular invasion, and/or new lesions was 13.8 months (confidence interval: 11.3-17.7 months). Of the 209 patients followed until death, only 50 developed extrahepatic metastases (24%). Multivariate analyses identified age <65 years (P = 0.038), alpha-fetoprotein >200 ng/mL (P = 0.04), and vascular invasion (P = 0.017) as significant predictors of metastases development.
  
  
  CONCLUSIONS
  Knowledge of the risk factors associated with the development of metastases may help guide assessment of patient prognosis. Because 76% of patients presenting with local disease treated with locoregional therapies die without developing extrahepatic metastases, the notion of HCC as a systemic disease, as detected by imaging, may be reconsidered.
authors: Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors: Seanthan
authors: S
authors: Senthilnathan
authors: Khairuddin
authors: K
authors: Memon
authors: Robert J
authors: RJ
authors: Lewandowski
authors: Laura
authors: L
authors: Kulik
authors: Mary F
authors: MF
authors: Mulcahy
authors: Ahsun
authors: A
authors: Riaz
authors: Frank H
authors: FH
authors: Miller
authors: Vahid
authors: V
authors: Yaghmai
authors: Paul
authors: P
authors: Nikolaidis
authors: Edward
authors: E
authors: Wang
authors: Talia
authors: T
authors: Baker
authors: Michael
authors: M
authors: Abecassis
authors: Al B
authors: AB
authors: Benson
authors: Reed A
authors: RA
authors: Omary
authors: Riad
authors: R
authors: Salem
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D008175:Lung Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000556:secondary*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000556:secondary*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome