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Extrahepatic metastases occur in a minority of hepatocellular carcinoma patients treated with locoregional therapies: Analyzing patterns of progression in 285 patients
Author(s) -
Senthilnathan Seanthan,
Memon Khairuddin,
Lewandowski Robert J.,
Kulik Laura,
Mulcahy Mary F.,
Riaz Ahsun,
Miller Frank H.,
Yaghmai Vahid,
Nikolaidis Paul,
Wang Edward,
Baker Talia,
Abecassis Michael,
Benson Al B.,
Omary Reed A.,
Salem Riad
Publication year - 2012
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.24812
Subject(s) - medicine , hepatocellular carcinoma , interquartile range , tumor progression , multivariate analysis , oncology , cancer , gastroenterology , carcinoma , lymph node , radiology
Although most cancers are considered predominantly systemic processes, this may not hold true for hepatocellular carcinoma (HCC). The literature regarding patterns of progression of HCC (local versus systemic) has been relatively sparse. Our objectives were to: (1) analyze patterns of progression in HCC patients presenting with intrahepatic disease from initial treatment until death, and (2) identify clinically relevant risk factors for the development of metastases. Over a 9‐year period, 285 patients treated with transarterial locoregional therapies underwent scheduled imaging follow‐up from treatment until death and were categorized by pattern of progression: (i) intrahepatic (increased tumor enhancement/size, development/progression of vascular invasion, new hepatic lesions) progression or (ii) extrahepatic (adrenal/bone/lung/lymph node) metastases. Uni/multivariate analyses assessing the risk factors for the development of metastases were performed. The median time from last scan to death was 2.4 months (interquartile range: 1.3‐4.8 months). The time to development of metastases, vascular invasion, and/or new lesions was 13.8 months (confidence interval: 11.3‐17.7 months). Of the 209 patients followed until death, only 50 developed extrahepatic metastases (24%). Multivariate analyses identified age <65 years ( P = 0.038), alpha‐fetoprotein >200 ng/mL ( P = 0.04), and vascular invasion ( P = 0.017) as significant predictors of metastases development. Conclusion: Knowledge of the risk factors associated with the development of metastases may help guide assessment of patient prognosis. Because 76% of patients presenting with local disease treated with locoregional therapies die without developing extrahepatic metastases, the notion of HCC as a systemic disease, as detected by imaging, may be reconsidered. (H EPATOLOGY 2011)