Frequency, Morbidity, and Mortality of Bone Metastases in Advanced Hepatocellular Carcinoma
Frequency, Morbidity, and Mortality of Bone Metastases in Advanced Hepatocellular Carcinoma
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DOI：
10.6004/jnccn.2017.7024
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发表时间：
2018-01-01
影响因子：
13.4
通讯作者：
Abou-Alfa, Ghassan K.
中科院分区：
文献类型：
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作者：
Harding, James J.;Abu-Zeinah, Ghaith;Abou-Alfa, Ghassan K.
背景：骨转移在肝细胞癌（HCC）中很常见，但其发病率、发病率和死亡率尚不明确。方法：查询2002 - 2014年纪念斯隆-凯特琳癌症中心数据库中所有肝癌和转移患者的资料。确定骨转移的患病率，并使用累积发生率函数来估计发生骨转移的概率。建立回归模型以确定骨转移的危险因素。确定骨相关事件（SREs）的频率，定义为病理性骨折、脊髓压迫、需要骨放射治疗和/或手术切除骨，并使用累积发生率函数来估计SRE发生的概率。建立回归模型以确定SRE的危险因素。采用Kaplan-Meier方法分析临床病理参数（包括骨转移和SREs）与总生存率的相关性。结果：共确诊肝癌合并肝外转移患者459例；151例（32.9%）患者发生或发生骨转移：128例（27.9%）为原发性肝外疾病，23例（4.6%）为继发性肝外疾病。在331例发病时无骨转移的患者中，骨转移的年发生率为6.4% （95% CI, 3.6%-9.2%）。乙型肝炎病毒（HBV）感染增加了发生骨转移的机会（P= 0.02）。6个月时SREs的累积发生率为50%。单因素分析显示，hbv相关HCC患者的SREs发生率显著升高（P= 0.02）。索拉非尼和双膦酸盐均可预防SREs。SREs的存在与较差的总生存率独立相关(风险比，2.13;95% CI, 1.52-2.97； P
Background: Bone metastases are common in hepatocellular carcinoma (HCC), but their incidence, morbidity, and mortality are not well defined. Methods: The Memorial Sloan Kettering Cancer Center database was queried for all patients with HCC and metastases seen from 2002 to 2014. The prevalence of bone metastasis was determined and cumulative incidence function was used to estimate the probability of developing a bone metastasis. Regression models were created to identify risk factors for osseous metastasis. The frequency of skeletal-related events (SREs), defined as pathologic fracture, spinal cord compression, need for radiation therapy to bone, and/or surgical resection of bone, was determined and cumulative incidence function was used to estimate the probability of SRE development. Regression models were created to identify SRE risk factors. Correlation of clinicopathologic parameters, including bone metastases and SREs, with overall survival was analyzed using Kaplan-Meier methodology. Results: A total of 459 patients with HCC and extrahepatic metastases were identified; 151 patients (32.9%) had or developed bone metastases: 128 (27.9%) as a primary site and 23 (4.6%) as a secondary site of extrahepatic disease. Among the 331 patients without bone metastasis at presentation, the yearly incidence of bone metastasis was 6.4% (95% CI, 3.6%-9.2%). Hepatitis B virus (HBV) infection increased the chance of developing a bone metastasis (P=.02). The cumulative incidence of SREs was 50% at 6 months. Univariate analysis showed that patients with HBV-related HCC had a significantly higher incidence of SREs (P=.02). Sorafenib and bisphosphonates each protected against SREs. The presence of SREs was independently associated with a worse overall survival (hazard ratio, 2.13; 95% CI, 1.52-2.97; P