Copyright
©2008 The WJG Press and Baishideng.
World J Gastroenterol. Oct 7, 2008; 14(37): 5717-5722
Published online Oct 7, 2008. doi: 10.3748/wjg.14.5717
Published online Oct 7, 2008. doi: 10.3748/wjg.14.5717
Table 1 Guidelines for pulmonary metastasectomy1
Primary lesion | Metastatic lesion | Patient factor |
Completely cured | Therapeutic intents | Tolerable margin of safety in lung function |
Controllable surgically or with other modalities after metastasectomy | Diagnostic intents (true malignancy, evaluate chemotherapy) | Good risk for other organ functions (heart and cerebral status) |
Table 2 Clinical findings of 16 patients with HCC who underwent pulmonary metastasectomy
Clinical findings | Number of patients (n = 16) | Percents of patients (%) |
Gender: male/female | 14/2 | 87.5/12.5 |
Age at pulmonary resection (yr) | 45 ± 9.8 (31-67)1 | |
Etiology of liver diseases | ||
Cirrhosis + HCC + HBV | 5 | 31.3 |
Cirrhosis + HCC | 2 | 12.5 |
Alcoholic liver disease + HCC | 2 | 12.5 |
HCC + HBV | 7 | 43.8 |
Maximal diameter of lung lesions | 13 ± 10 (3-50 mm) | |
Treatment of primary lesion2 | ||
Hepatic resection | 5 | 31.3 |
Liver transplantation | 7 | 43.8 |
Local therapy | 5 | 31.3 |
Treatment of lung lesions2 | ||
Thoracoscopic resection | 15 | 93.8 |
Open wedge resection | 9 | 56.3 |
Lobectomy | 1 | 6.3 |
Tomotherapy after recurrence | 2 | 12.5 |
Maximal diameter of lung lesions | 13 ± 10 (3-50 mm) | |
Number of lung metastasectomy | ||
1 | 9 | 56.2 |
≥ 2 | 7 | 43.8 |
HBV hepatitis | ||
Yes | 12 | 75.0 |
No | 4 | 25.0 |
HCC pathologic finding | ||
Well differentiated | 7 | 43.8 |
Poorly differentiated | 9 | 56.2 |
Alpha fetoprotein | ||
> 20 ng/mL | 8 | 50.0 |
< 20 ng/mL | 8 | 50.0 |
Liver cirrhosis | ||
Yes | 7 | 43.8 |
No | 9 | 56.3 |
Table 3 Follow-up results of 16 patients with HCC after pulmonary metastasectomy
Number of patients (n = 16) | Percentages of patients (%) | |
Status at the last observation period | ||
Survival without recurrence | 4 | 25.0 |
Survival with recurrence | 1 | 6.25 |
Died of recurrence, cachexia | 4 | 25.0 |
Died of hepatic failure + recurrence | 6 | 37.5 |
Died of hepatic failure | 1 | 6.25 |
Table 4 Cox’s proportional hazards model of all factors predicting increased survival after pulmonary metastasectomy in patients with HCC
Prognostic factors | Parameter estimate (β) | P | HR | 95% confidence interval |
Disease-free interval ( ≤ 12 vs > 12 mo) | 1.97545 | 0.4005 | 7.21 | 0.072-721.009 |
HBV viral hepatitis (vs no) | -33.8718 | 0.9906 | 0 | 0-. |
Well differentiation grade (vs poorly) | -18.73237 | 0.9896 | 0 | 0-. |
α-feto protein > 20 ng/mL (yes vs no) | -4.49444 | 0.0748 | 0.011 | .-1.569 |
Liver transplantation (vs no) | 32.71851 | 0.9818 | 1.62E + 14 | 0-. |
Single metastasectomy (vs multiple) | -15.0999 | 0.0572 | 0 | 0-1.83 |
Thoracoscopy (vs others) | -13.02123 | 0.9928 | 0 | 0-. |
Age | 0.55293 | 0.0419 | 1.738 | 1.021-2.961 |
Table 5 Cox’s proportional hazards model of liver transplantation, HBV viral hepatitis, well differentiation grade predicting increased survival after pulmonary metastasectomy in patients with HCC
Prognostic factors | Parameter estimate (β) | P | HR | 95% confidence interval |
HBV viral hepatitis (vs no) | -0.33272 | 0.7674 | 0.717 | 0.079-6.504 |
Well differentiation grade (vs poorly) | -0.7663 | 0.3007 | 0.465 | 0.109-1.984 |
Liver transplantation (vs no) | 1.26672 | 0.1568 | 3.549 | 0.615-20.495 |
- Citation: Kwon JB, Park K, Kim YD, Seo JH, Moon SW, Cho DG, Kim YW, Kim DG, Yoon SK, Lim HW. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: Analysis of prognostic factors. World J Gastroenterol 2008; 14(37): 5717-5722
- URL: https://www.wjgnet.com/1007-9327/full/v14/i37/5717.htm
- DOI: https://dx.doi.org/10.3748/wjg.14.5717