title: Brain metastasis from hepatocellular carcinoma: the role of surgery as a prognostic factor.
abstract: BACKGROUND
  The incidence of brain metastasis from hepatocellular carcinoma (HCC) is expected to increase as a result of prolonged survival due to the recent advances in HCC treatment. However, there is no definite treatment strategy for brain metastasis from HCC mainly due to its rarity and dismal prognosis. To provide helpful recommendations in treatment of brain metastasis from HCC, the authors aimed to identify prognostic factors that influence survival rates with a review of the recently published data.
  
  
  METHODS
  Thirty-three cases of brain metastasis, whose incidence was 0.65%, were selected from a total of 5015 HCC patients and reviewed retrospectively in terms of clinical and radiological features.
  
  
  RESULTS
  Median overall survival time after diagnosis of brain metastasis was 10.4 weeks (95% confidence interval [CI], 5.1-15.7 weeks) with 1-, 6- and 12-month survival rates, of 79%, 24% and 6%, respectively. Median survival of the patients treated with surgical resection or surgical resection followed by whole-brain radiation therapy (WBRT) (25.3 weeks; range, 15.8-34.8 weeks) was longer than that of the patients treated with gamma knife surgery (GKS), WBRT, or GKS followed by WBRT (10.4 weeks; range, 7.5-13.3 weeks) as well as that of patients treated with only steroids (1 week; range, 0.0-3.3 weeks) (p<0.001). Child-Pugh's classification A group had a longer median survival time than Child-Pugh's classification B or C group (14.4 weeks vs 8.4 weeks, p=0.038). RPA class I & II group had also a longer median survival time than RPA class III group did (13.4 weeks vs 2.4 weeks, p=0.001). Surgical resection (hazard ratio [HR] 0.23, 95% CI 0.08-0.66, p=0.006) and good liver function at the time of brain metastasis (HR 0.25, 95% CI 0.09-0.69, p=0.007) were found to be the powerful prognostic factors for favorable survival in the multivariate analysis. In addition, presence of intratumoral hemorrhage was a statistically significant prognostic factor for survival.
  
  
  CONCLUSIONS
  Although HCC patients with brain metastasis showed a very dismal prognosis, surgical intervention was shown to lead to relative prolongation of the survival time, especially in those with preserved hepatic function.
authors.forename: Moon-Soo
authors.initials: MS
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, South Korea. moonks@chonnam.ac.kr.
authors.forename: Kyung-Sub
authors.initials: KS
authors.lastname: Moon
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Lee
authors.forename: Sung-Bum
authors.initials: SB
authors.lastname: Cho
authors.forename: Sa-Hoe
authors.initials: SH
authors.lastname: Lim
authors.forename: Woo-Youl
authors.initials: WY
authors.lastname: Jang
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.forename: In-Young
authors.initials: IY
authors.lastname: Kim
authors.forename: Shin
authors.initials: S
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult