Hepatocellular Carcinoma With Extrahepatic Metastasis Clinical Features and Prognostic Factors
Hepatocellular Carcinoma With Extrahepatic Metastasis Clinical Features and Prognostic Factors
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DOI：
10.1002/cncr.25960
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发表时间：
2011-10-01
期刊：
影响因子：
6.2
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Uchino, Koji;Tateishi, Ryosuke;Koike, Kazuhiko
背景技术背景：尽管肝内病变的治疗取得了重大进展，但肝细胞癌（HCC）肝外转移患者的预后仍然很差。本研究的目的是进一步阐明这种疾病患者的临床病程和预后决定因素。方法：共纳入342例HCC伴肝外转移患者。28例患者在最初表现为HCC时诊断出转移，其余患者在随访期间诊断出转移。作者分析了临床特征、疾病和治疗，并使用具有测试集和训练集的分裂样本方法建立了预测预后的评分系统。结果：肝外转移最常见的部位是肺，其次是淋巴结、骨和肾上腺。这些转移与死亡直接相关，只有23例（7.6%）。诊断肝外转移后的中位生存期为8.1个月（范围，0.03-108.7个月）。在训练集（n = 171）的单变量分析中，体能状态、Child-Pugh分级、肝内病变的数量和大小、肉眼血管侵犯、症状性肝外转移、甲胎蛋白水平和治疗完全缓解与预后显著相关。在多变量分析的基础上，开发了一个评分系统来预测预后，该系统评估了无法控制的肝内病变、血管侵犯的程度和体力状态。该评分系统在测试集（n 171）中得到验证，产生的一致性指数为0.73。结论：肝内病灶的可控性和体力状态被确定为晚期肝癌肝外转移患者的重要预后因素。Cancer 2011; 117：4475-83. (C)2011年美国癌症协会
BACKGROUND: Despite significant advances in the treatment of intrahepatic lesions, the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. The objective of this study was to further elucidate the clinical course and prognostic determinants of patients with this disease. METHODS: In total, 342 patients who had HCC with extrahepatic metastasis were enrolled. The metastases were diagnosed at initial presentation with HCC in 28 patients and during follow-up in the remaining patients. The authors analyzed clinical features, prognoses, and treatments and established a scoring system to predict prognosis using a split-sample method with a testing set and a training set. RESULTS: The most frequent site of extrahepatic metastasis was the lung followed by lymph nodes, bone, and adrenal glands. These metastases were related directly to death in only 23 patients (7.6%). The median survival after diagnosis of extrahepatic metastasis was 8.1 months (range, 0.03-108.7 months). In univariate analysis of the training set (n = 171), performance status, Child-Pugh classification, the number and size of intrahepatic lesions, macroscopic vascular invasion, symptomatic extrahepatic metastases, alpha-fetoprotein levels, and complete responses to treatment were associated significantly with prognosis. On the basis of multivariate analysis, a scoring system was developed to predict prognosis that assessed uncontrollable intrahepatic lesions, extent of vascular invasion, and performance status. This scoring system was validated in the testing set (n 171) and produced a concordance index of 0.73. CONCLUSIONS: The controllability of intrahepatic lesions and performance status were identified as important prognostic factors in patients with advanced HCC who had extrahepatic metastasis. Cancer 2011; 117: 4475-83. (C) 2011 American Cancer Society.