Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: Analysis of prognostic factors

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)

¹Modified from others and us[18,19].

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

¹mean ± SD (range);

²Multiple therapies were performed.

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