title: A Systematic Review of Metastatic Hepatocellular Carcinoma to the Spine.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) frequently metastasizes to the spine. The impact of medical and/or surgical intervention on overall survival has been examined in a limited number of clinical studies, and herein we systematically review these data.
  
  
  METHODS
  We performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles that reported survival, clinical outcomes, and/or prognostic factors associated with patients diagnosed with spinal metastases. The methodologic quality of each review was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool.
  
  
  RESULTS
  There were 26 articles (152 patients) that met the inclusion criteria and were treated with either surgery, radiotherapy, chemotherapy, and/or observation. There were 3 retrospective cohort studies, 17 case reports, 5 case series, and 1 longitudinal observational study. Of the patients with known overall survival after diagnosis of spinal metastasis, survival at 3 months, 6 months, 1 year, 2 years, and 5 years was 95.2%, 83.0%, 28.6%, 2.0%, and 1.4%, respectively. The median survival after diagnosis of the metastasis was 0.7 months in the patients who received no treatment, 7 months in the patients treated with surgical intervention alone, 6 months for patients who received chemotherapy and/or radiation, and 13.5 months in the patients treated with a combination of surgery and medical management. All other clinical or prognostic parameters were of low or insufficient strength.
  
  
  CONCLUSIONS
  Patients diagnosed with HCC spinal metastasis have a 10.6-month overall survival. Further analysis of patients in prospective controlled trials will be essential to the development of treatment algorithms for these patients in the future.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Yanamadala
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ruiz-Valls
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abu-Bonsrah
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Shankar
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Boone
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
authors.affiliation: Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bilsky
authors.affiliation: Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000628:therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; Liver cancer; Spine metastasis; Surgery; Survival; Tumor