title: Prognostic Analysis of Surgical Resection for Pulmonary Metastasis from Hepatocellular Carcinoma.
abstract: Pulmonary metastases are the most common among extrahepatic recurrences from hepatocellular carcinoma (HCC). It causes high risk of HCC-related death, despite recent progress in therapeutic options. However, a role of pulmonary metastasectomy as well as prognostic factors after metastasectomy has not been well established. We aimed to investigate survival outcomes and prognostic factors after pulmonary resection for metastases from HCC.
  
  
  
  A series of 93 patients who underwent pulmonary resections for metastases from HCC between June 1990 and July 2013 from multi-institutional database were retrospectively evaluated. Perioperative clinicopathological data and their association with prognosis were investigated.
  
  
  
  Of 93 patients, 77 had one pulmonary metastasis, and 16 had two or more. Recurrence after pulmonary resection was noted in 60 patients (64.5 %). The estimated 5-year overall survival rate was 41.4 % with median survival time after pulmonary metastatectomy of 39.0 months. Univariate prognostic analysis showed that disease-free interval of ≥12 months was significantly associated with favorable outcomes in both overall survival (5-year rate, 59.3 vs. 28.7 %, p = 0.026) and disease-specific survival (5-year rate, 62.5 vs. 36.2 %; p = 0.038) after pulmonary metastatectomy. A multivariate analysis revealed that disease-free interval was an independent prognostic factor (HR = 2.020, 95 % CI, 1.069-3.816, p = 0.030).
  
  
  
  We have shown that a disease-free interval was an independent prognostic factor in patients who underwent pulmonary resection for metastasis from HCC. Also, pulmonary metastasectomy can be one of the therapeutic choices for select patients.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. yusuketakahashigts@gmail.com.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ikeda
authors.affiliation: Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.affiliation: Osaka University Graduate School of Medicine, Suita Osaka, Japan.
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Sawabata
authors.affiliation: Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Chida
authors.affiliation: Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Horio
authors.affiliation: Department of Chest Surgery, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Okumura
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Masafunmi
authors.initials: M
authors.lastname: Kawamura
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate