title: Screening for extrahepatic metastases by additional staging modalities is required for hepatocellular carcinoma patients beyond modified UICC stage T1.
abstract: OBJECTIVE
  Accurate staging of hepatocellular carcinoma (HCC) is critical for guiding optimal treatment, and the presence of extrahepatic metastases (EHM) can seriously affect the optimal choice of treatment in the sorafenib era. However, there is limited data about when and how to screen EHM for newly diagnosed HCC patients, especially for patients without symptoms or signs of EHM.
  
  
  METHODS
  We analyzed 314 newly diagnosed HCC patients who had no symptoms or signs of EHM and who had undergone additional modalities.
  
  
  RESULTS
  EHM was found in 50 of 314 patients (15.9%). Fifteen of 50 EHM (30%) were missed by conventional modalities but revealed by additional modalities. The frequency of EHM were 0% (0/26), 7.6% (10/131), 25.0% (30/120) and 27.0% (10/37) for the modified UICC stages T1, T2, T3 and T4, respectively (p<0.001). The proportions of EHM detected by additional modalities were 50% (5/10 EHM), 33% (10/30 EHM) and 0% (0/10 EHM) for modified UICC stages T2, T3 and T4, respectively.
  
  
  CONCLUSIONS
  Application of additional staging modalities resulted in change of HCC stage in a significant proportion of HCC patients beyond modified UICC stage T1 by revealing EHM that had not been detected by conventional modalities.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jieun
authors.initials: J
authors.lastname: Yi
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ha Na
authors.initials: HN
authors.lastname: Kim
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
authors.forename: Joon Hyeok
authors.initials: JH
authors.lastname: Lee
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18