title: Prevalence and outcomes of extrahepatic primary malignancy associated with hepatocellular carcinoma in a Korean population.
abstract: BACKGROUND
  With advances in hepatocellular carcinoma (HCC) screening and treatment, the incidence of diagnosing a case of extrahepatic primary malignancy (EHPM) in patients with HCC has increased. This study aimed to elucidate the prevalence and clinical outcomes of EHPM in patients with HCC who underwent curative resection in Korea.
  
  
  METHODS
  The clinical data of 250 patients with HCC who underwent curative resection in our hospital from May 2003 to December 2011 were retrospectively analyzed. The clinical features, overall survival, and causes of death were compared between patients with HCC with or without EHPM.
  
  
  RESULTS
  The prevalence of EHPM among the 250 patients was 13.2% (n = 33). The most common site of EHPM was the colorectal (n = 10), followed by the stomach (n = 9), breasts (n = 4), and kidneys (n = 3). Patients with EHPM were significantly older, and they presented with higher rates of comorbidities, a different etiology of HCC, and better liver function than patients without EHPM. Interestingly, overall survival was significantly lower in the EHPM group, which more frequently displayed extrahepatic causes of death. Moreover, the presence of EHPM was an independent factor for overall survival in the study population.
  
  
  CONCLUSIONS
  The prevalence of EHPM in patients with HCC who underwent curative surgical resection was 13.2% in Korea, with colorectal and stomach cancers comprising most EHPMs (88%). The patients with EHPM displayed significantly worse survival because of extrahepatic causes of death, which should be considered in the management of HCC in the future.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. sukhoHong727@gmail.com.
authors.forename: Sukho
authors.initials: S
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. jsh@snubh.org.
authors.forename: Sook-Hyang
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. 3939lee@naver.com.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. jjungwha@snubh.org.
authors.forename: Jung Wha
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. doctor2475@gmail.com.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. missyouso@hanmail.net.
authors.forename: Seong Min
authors.initials: SM
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. janges@snubh.org.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. kimjw@snubh.org.
authors.forename: Jin-Wook
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea. jhkimmd@snubh.org.
authors.forename: Jee Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea. hkim759@snubh.org.
authors.forename: Haeryoung
authors.initials: H
authors.lastname: Kim
authors.affiliation: Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea. jycho@snubh.org.
authors.forename: Jai Young
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea. yoonys@snubh.org.
authors.forename: Yoo-Seok
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea. hanhs@snubh.org.
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Han
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000401:mortality*; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome