Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors
Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors
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DOI：
10.1007/s00432-008-0410-6
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发表时间：
2008-12-01
影响因子：
3.6
通讯作者：
Han, Kwang-Hyub
中科院分区：
文献类型：
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作者：
Kim, Seung Up;Kim, Do Young;Han, Kwang-Hyub
目的随着各种诊断工具和治疗方式的改进，肝细胞癌（HCC）患者的生存期已延长。因此，HCC的骨转移更频繁地被诊断出来。我们调查了肝癌骨转移的临床特征、预后、治疗结果和预后因素，在2000年6月至2007年4月期间，我们招募了37例连续的肝癌骨转移患者。结果本组患者平均年龄61.1岁（男：女，31：6），平均住院时间12个月，平均住院时间12个月。肝细胞癌最常见的病因是B型肝炎病毒感染（56.8%）。22例患者（59.5%）为Child-Pugh A级，15例（40.5%）为Child-Pugh B级。脊柱转移最常见，21例（56.7%）。治疗组的治疗方式包括9例（42.8%）动脉内化疗，5例（23.8%）全身化疗，7例（33.4%）动脉内和全身化疗。所有患者的中位生存期为6.2个月（范围0.7-46.6），未治疗对照组和治疗组的中位生存期分别为2.9个月（范围0.7-42.2）和9.7个月（范围0.9-46.6），无显著性差异（log-rank检验，P = 0.081）。考克斯回归分析显示，最初出现腹水是唯一的预后因素（P = 0.016）。结论尽管我们的研究表明，对于最初伴有骨转移的肝癌患者，与支持治疗相比，局部和/或全身化疗并不能显着延长生存期，但可能需要更大规模的随机研究。
Purpose The survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and treatment modalities. Consequently, bone metastases from HCC are diagnosed more frequently. We investigated the clinical features, prognosis, treatment outcomes, and prognostic factors of HCC presenting with bone metastasis.Methods Between June 2000 and April 2007, we recruited 37 consecutive HCC patients presenting with bone metastasis. These patients were divided into an untreated control group (n = 16) and a treated group (n = 21).Results The mean age of the patients was 61.1 years (male:female, 31:6). The most common cause of HCC was hepatitis B virus infection (56.8%). Twenty-two patients (59.5%) were of Child-Pugh class A and 15 (40.5%) were of Child-Pugh class B. Spinal metastasis was most common and noted in 21 patients (56.7%). The treatment modalities in the treated group included intra-arterial chemotherapy in nine patients (42.8%), systemic chemotherapy in five (23.8%), and both intra-arterial and systemic chemotherapy in seven (33.4%). The median survival of all patients was 6.2 months (range 0.7-46.6); that of untreated control group and the treated group was 2.9 (range 0.7-42.2) and 9.7 (range 0.9-46.6) months, respectively, with no significant difference (log-rank test, P = 0.081). Cox regression analysis revealed that the presence of ascites at the initial presentation was the only prognostic factor (P = 0.016).Conclusion Although our study showed that locoregional and/or systemic chemotherapy did not provide significant survival prolongation compared to supportive care in patients with HCC initially accompanied by bone metastasis, a more large-scaled randomized study might be required.