title: Brain metastases from hepatocellular carcinoma: clinical features and prognostic factors.
abstract: BACKGROUND
  Brain metastases (BM) from hepatocellular carcinoma (HCC) are extremely rare and are associated with a poor prognosis. The aim of this study was to define clinical outcome and prognostic determinants in patients with BM from HCC.
  
  
  METHODS
  Between January 1994 and December 2009, all patients with HCC and BM treated in Sun Yat-sen University Cancer Center were retrospectively reviewed. Univariate and multivariate survival analyses were performed to identify possible prognostic factors.
  
  
  RESULTS
  Forty-one patients were diagnosed with BM from HCC, an incidence of 0.47%. The median age at diagnosis of BM was 48.5 years. Thirty-three patients (80.5%) developed extracranial metastases at diagnosis of BM, and 30 patients (73.2%) had hepatitis B. Intracranial hemorrhage occurred in 19 patients (46.3%). BM were treated primarily either with whole brain radiation therapy (WBRT; 5 patients), stereotactic radiosurgery (SRS; 7 patients), or surgical resection (6 patients). The cause of death was systemic disease in 17 patients and neurological disease in 23. Patients in a high RPA (recursive partitioning analysis) class, treated with conservatively and without lung metastases, tended to die from neurological disease. Median survival after the diagnosis of BM was 3 months (95% confidence interval: 2.2-3.8 months). In multivariate analysis, the presence of extracranial metastases, a low RPA class and aggressive treatment, were positively associated with improved survival.
  
  
  CONCLUSIONS
  BM from HCC is rare and associated with an extremely poor prognosis. However, patients with a low RPA class may benefit from aggressive treatment. The clinical implication of extracranial metastases in HCC patients with BM needs further assessment.
authors.affiliation: State Key Laboratory of Oncology in South China and Department of Neurosurgery, Sun Yat-sen University Cancer Center, No, 651, Dong Feng Road East, Guangzhou 510060, People's Republic of China.
authors.forename: Xiao-Bing
authors.initials: XB
authors.lastname: Jiang
authors.forename: Chao
authors.initials: C
authors.lastname: Ke
authors.forename: Guan-Hua
authors.initials: GH
authors.lastname: Zhang
authors.forename: Xiang-Heng
authors.initials: XH
authors.lastname: Zhang
authors.forename: Ke
authors.initials: K
authors.lastname: Sai
authors.forename: Zhong-Ping
authors.initials: ZP
authors.lastname: Chen
authors.forename: Yong-Gao
authors.initials: YG
authors.lastname: Mou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D006528:Carcinoma, Hepatocellular / Q000556:secondary*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult