Concomitant lung metastasis in patients with advanced hepatocellular carcinoma.
Concomitant lung metastasis in patients with advanced hepatocellular carcinoma.
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DOI：
10.3748/wjg.v18.i20.2533
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发表时间：
2012-05
影响因子：
4.3
通讯作者：
Tian Yang;Jun-hua Lu;Chuan Lin;S. Shi;Ting-Hao Chen;Rong-Hua Zhao;Yi Wang;Meng‐chao Wu
中科院分区：
文献类型：
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作者：
Tian Yang;Jun-hua Lu;Chuan Lin;S. Shi;Ting-Hao Chen;Rong-Hua Zhao;Yi Wang;Meng‐chao Wu
目的探讨初诊时伴有肺转移的晚期肝细胞癌（HCC）患者的临床特点及预后因素。方法：在2001年至2010年期间，我们招募了76例连续的HCC患者，这些患者最初表现为肺转移，没有其他部位的转移。将患者分为3组：未治疗组（n = 22）、单一治疗组（n = 19）、联合治疗组（n = 35）。结果35例（46.1%）患者双侧肺叶转移较为常见，多数患者（59/76,77.6%）表现为多发肺转移结节。19例（25.0%）患者接受单一方法治疗，包括肝切除术4例，经导管动脉化疗栓塞6例，放疗5例，口服索拉非尼4例。35例患者（46.1%）接受联合治疗。所有患者的总中位生存期为8.7±0.6个月；未治疗组、单一治疗组、联合治疗组分别为4.1±0.3、6.3±2.5、18.6±3.9个月，差异有统计学意义（log-rank检验，P < 0.001）。多因素分析显示Child-Pugh评分、有无门静脉肿瘤血栓、治疗方式是影响晚期HCC伴肺转移患者生存的三个独立预后因素。结论对于以肺转移为首发的HCC患者，联合治疗方式比保守治疗或单一治疗方式有更好的生存率。
AIM To investigate the clinical features and prognostic factors of advanced hepatocellular carcinoma (HCC) patients presenting with lung metastasis at initial diagnosis. METHODS Between 2001 and 2010, we recruited 76 consecutive HCC patients initially presenting with lung metastasis, without co-existing metastasis from other sites. These patients were divided into three groups: untreated group (n = 22), single treatment group (n = 19), and combined treatment group (n = 35). RESULTS Metastasis of bilateral lung lobes was common and noted in 35 patients (46.1%), and most of patients (59/76, 77.6%) presented with multiple lung metastatic nodules. Nineteen patients (25.0%) received single-method treatment, including hepatectomy in 4, transcatheter arterial chemoembolization in 6, radiotherapy in 5, and oral sorafenib in 4. Thirty-five patients (46.1%) received combined treatment modalities. The overall median survival of the all patients was 8.7 ± 0.6 mo; 4.1 ± 0.3, 6.3 ± 2.5 and 18.6 ± 3.9 mo, respectively in the untreated group, single treatment group and combined treatment group, respectively, with a significant difference (log-rank test, P < 0.001). Multivariate analysis revealed that Child-Pugh score, the absence or presence of portal vein tumor thrombus, and treatment modality were three independent prognostic factors affecting survival of patients with advanced HCC and concomitant lung metastasis. CONCLUSION Combined treatment modalities tend to result in a better survival as compared with the conservative treatment or single treatment modality for HCC patients initially presenting with lung metastasis.