Positive lymph node metastasis has a marked impact on the long-term survival of patients with hepatocellular carcinoma with extrahepatic metastasis.
BACKGROUND
The prognosis of hepatocellular carcinoma (HCC) patients with extrahepatic metastasis is extremely poor. However, what is the main risk factor for survival remains unclear for these patients. We aimed to find out the relative frequency, incidence and locations of extrahepatic metastases and the risk factors of long-term survival of the patients.


METHODS
132 HCC patients with extrahepatic metastasis diagnosed by 18F-FDG PET/CT and conventional workup were enrolled into this study. The incidence and locations of extrahepatic metastases were summarized, and the related risk factors of overall survival were analyzed.


RESULTS
The most frequent extrahepatic metastatic sites were lymph nodes in 72 (54.5%), bone in 33 (25.0%) and lung in 28 (21.2%) patients. On univariate analysis, prothrombin time, Child-Pugh grade, portal/hepatic vein invasion and lymph node metastasis were independent risk factors of overall survival. On multivariate analysis, lymph node metastasis was the only independent risk factor of overall survival. The cumulative survival rates at 1- and 3-years after diagnosis of extrahepatic metastasis of HCC were 34.4% and 9.3%, respectively. The median survival time was 7 months (range 1 ∼38 months). The median survival time for patients with or without lymph node metastasis were 5 months (range 1∼38 months) and 12 months (range 1∼30 months), respectively (P = 0.036).


CONCLUSIONS
This study showed lymph nodes to be the most frequent site of extrahepatic metastases for primary HCC. Lymph node metastasis was the main risk factor of overall survival in patients with HCC with extrahepatic metastasis.
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Feng
F
Xia
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Lin
L
Wu
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Wan-Yee
WY
Lau
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Guo
G
Li
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Hongbo
H
Huan
Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Cheng
C
Qian
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Kuansheng
K
Ma
Institute of Hepatobiliary Surgery and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
Ping
P
Bie
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014055:Tomography, Emission-Computed / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18