title: Hepatocellular Carcinoma Extrahepatic Metastasis in Relation to Tumor Size and Alkaline Phosphatase Levels.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is known to metastasize. However, there are few reports on patients with metastasis at the time of HCC diagnosis.
  
  
  OBJECTIVE
  To evaluate the incidence and characteristics of extrahepatic metastasis patients presenting at baseline with noncurable, advanced HCC.
  
  
  RESULTS
  The total HCC cohort was initially dichotomized into 2 subcohorts, with (n = 214) and without (n = 719) extrahepatic metastasis ('metastasis'), and patient baseline characteristics were compared. The main findings for patients with metastasis (22.9% of total cohort) compared with other, nonmetastatic patients were: more advanced tumors, as judged by larger tumor diameters, more tumor multifocality and percent with portal vein thrombosis, higher blood α-fetoprotein and des x03B3;-carboxy prothrombin levels and alkaline phosphatase (ALKP), but not bilirubin levels, and a lower incidence of cirrhosis. There was a strong correlation between increases in tumor size and percent of patients with metastasis. A subset of patients with larger tumors was identified with low blood ALKP levels and better survival. Survival in the total metastasis cohort was lower than in the non-metastasis cohort, as expected, but only in patients with smaller tumors. In patients with larger tumors, survival with or without metastasis was similar and poor.
  
  
  CONCLUSIONS
  There was a lower incidence of cirrhosis in HCC patients with metastasis, and they had larger and more aggressive primary tumors. Patients with smaller, but not larger, tumors and metastasis had worse prognosis than patients without metastasis. A distinct subset of metastatic patients was identified that had better prognosis and low ALKP levels.
authors: Izmir Biomedicine and Genome Center, Dokuz Eylul University, Izmir, Turkey.
authors: Brian I
authors: BI
authors: Carr
authors: Vito
authors: V
authors: Guerra
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000453:epidemiology; D008113:Liver Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011516:Prothrombin / Q000378:metabolism; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins; D011516:Prothrombin; D000469:Alkaline Phosphatase; D001663:Bilirubin