Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. May 28, 2012; 18(20): 2533-2539
Published online May 28, 2012. doi: 10.3748/wjg.v18.i20.2533
Concomitant lung metastasis in patients with advanced hepatocellular carcinoma
Tian Yang, Jun-Hua Lu, Chuan Lin, Song Shi, Ting-Hao Chen, Rong-Hua Zhao, Yi Wang, Meng-Chao Wu
Tian Yang, Jun-Hua Lu, Chuan Lin, Song Shi, Yi Wang, Meng-Chao Wu, Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Ting-Hao Chen, Department of Hepatobiliary Surgery, the First People’s Hospital of Ziyang, Ziyang 641205, Sichuan Province, China
Rong-Hua Zhao, Department of Surgery, Royal University Hospital, College of Medicine University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
Author contributions: Yang T, Lu JH, Lin C and Shi S contributed equally to this work; Yang T, Lu JH, Lin C and Wu MC designed the research; Yang T, Shi S and Wang Y performed the research; Yang T, Lin C and Chen TH analyzed the data; Yang T, Zhao RH and Wang Y wrote the paper.
Supported by Grants from National Natural Science Foundation of China, No. 81000166; Shanghai Science and Technology Development Commission, No. 10411963300; Shanghai Program for Excellent Talents in Health System, No. XYQ2011033; and Shanghai Health Bureau, No. ab8307000-2010-92
Correspondence to: Meng-Chao Wu, MD, Professor of Surgery, Director of Eastern Hepatobiliary Surgery Hospital, Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. mengchao_wu@sina.com
Telephone: +86-21-81875293 Fax: +86-21-65566085
Received: July 27, 2011
Revised: February 8, 2012
Accepted: February 26, 2012
Published online: May 28, 2012
Abstract

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.

Keywords: Hepatocellular carcinoma; Lung metastasis; Prognosis; Survival; Prognostic factor