title: Prognostic value of site-specific extra-hepatic disease in hepatocellular carcinoma: a SEER database analysis.
abstract: BACKGROUND
  We the prognostic value of site-specific extra-hepatic disease in hepatocellular carcinoma (HCC) patients registered within the surveillance, epidemiology and end results (SEER) database.
  
  
  METHODS
  SEER database (2010-2013) has been queried through SEER*Stat program to determine the prognosis of advanced HCC patients according to the site of extra-hepatic disease. Survival analysis has been conducted through Kaplan Meier analysis.
  
  
  RESULTS
  A total of 4396 patients with stage IV HCC were identified in the period from 2010-2013 and they were included into this analysis. Patients with isolated regional lymph node involvement have better outcomes compared to patients with any other site of extra-hepatic disease (P < 0.0001 for both endpoints). Among patients with distant metastases, patients with bone metastases have better outcomes compared to patients with lung metastases (P < 0.0001 for both endpoints). Multivariate analysis revealed that younger age, normal alpha fetoprotein, single site of extra-hepatic disease, local treatment to the primary tumor and surgery to the metastatic disease were associated with better overall survival and liver cancer-specific survival.
  
  
  CONCLUSIONS
  Within the limits of the current SEER analysis, HCC patients with isolated lung metastases seem to have worse outcomes compared to patients with isolated bone or regional nodal metastases.​.
authors.affiliation: a Cancer Research Department , Swiss Cancer Institute , Cham , Switzerland ​.|b Department of General, Visceral and Transplant Surgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Hani
authors.initials: H
authors.lastname: Oweira
authors.affiliation: c Tumot immunology Department , Swiss Tumor Immunology Institute (SwissTII) , Zurich , Switzerland.
authors.forename: Ulf
authors.initials: U
authors.lastname: Petrausch
authors.affiliation: d Medical oncology , Gastrointestinal Tumor Center Zurich (GITZ) , Zurich , Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Helbling
authors.affiliation: e Surgery Department , Surgical Center Zurich - Hirslanden Hospital Zurich , Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: b Department of General, Visceral and Transplant Surgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.affiliation: e Surgery Department , Surgical Center Zurich - Hirslanden Hospital Zurich , Switzerland.
authors.forename: Othmar
authors.initials: O
authors.lastname: Schöb
authors.affiliation: a Cancer Research Department , Swiss Cancer Institute , Cham , Switzerland ​.
authors.forename: Anwar
authors.initials: A
authors.lastname: Giryes
authors.affiliation: a Cancer Research Department , Swiss Cancer Institute , Cham , Switzerland ​.|f Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
authors.forename: Omar
authors.identifier: http://orcid.org/0000-0002-5117-2502
authors.initials: O
authors.lastname: Abdel-Rahman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000509:alpha-Fetoproteins
keywords: Liver cancer; bone metastases; hepatocellular carcinoma; lung metastases; nodal metastases