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Erschienen in: Annals of Surgical Oncology 10/2010

01.10.2010 | Thoracic Oncology

Long-Term Survival and Prognostic Factors after Pulmonary Metastasectomy in Hepatocellular Carcinoma

verfasst von: Yoo Sang Yoon, MD, Hong Kwan Kim, MD, Jhingook Kim, MD, PhD, Yong Soo Choi, MD, Young Mog Shim, MD, PhD, Seung Woon Paik, MD, Kwhanmien Kim, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 10/2010

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Abstract

Background

The lung is the most common site of extrahepatic recurrence from hepatocellular carcinoma (HCC), but the standard treatment for pulmonary metastasis (PM) from HCC has not been established. We analyzed patients who underwent pulmonary resection for HCC metastases to evaluate long-term survival and prognostic factors.

Methods

We retrospectively reviewed patients who underwent pulmonary metastasectomy due to HCC at Samsung Medical Center between 1998 and 2008. Clinical/pathological features and prognoses were investigated.

Results

Fifty-two pulmonary metastasectomies were performed in 45 patients (38 men) with PM. Average patient age was 50.9 ± 11.0 years. Video-assisted thoracic surgery was used in 24 patients. Lobectomy was performed in eight patients and wedge resection in the others. Median survival after pulmonary metastasectomies was 40.7 months, and the 5-year overall survival rate was 37%. First recurrence in lung (P = 0.03), a long disease-free interval (P = 0.02), and solitary PM (P = 0.03) were found to be favorably associated with overall survival by univariate analysis. However, multivariate analysis failed to identify any independent prognostic factor associated with survival. Nevertheless, first recurrence in lung was found to be a favorable factor of PM-free survival by univariate (P = 0.01) and multivariate analyses (P = 0.022, hazard ratio = 0.382).

Conclusions

Pulmonary metastasectomies in selected patients with HCC was found to have a relatively good survival rate. Although no independent prognostic factor was found to be associated with overall survival, pulmonary metastasectomy may be effective in patients with a single PM and a long disease-free interval.
Literatur
2.
Zurück zum Zitat Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009;27:1485–91.CrossRefPubMed Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009;27:1485–91.CrossRefPubMed
3.
Zurück zum Zitat Bosetti C, Levi F, Boffetta P, et al. Trends in mortality from hepatocellular carcinoma in Europe, 1980–2004. Hepatology. 2008;48:137–45.CrossRefPubMed Bosetti C, Levi F, Boffetta P, et al. Trends in mortality from hepatocellular carcinoma in Europe, 1980–2004. Hepatology. 2008;48:137–45.CrossRefPubMed
4.
Zurück zum Zitat Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology. 1995;197:101–8.PubMed Livraghi T, Giorgio A, Marin G, et al. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection. Radiology. 1995;197:101–8.PubMed
5.
Zurück zum Zitat Tomimaru Y, Sasaki Y, Yamada T, et al. The significance of surgical resection for pulmonary metastasis from hepatocellular carcinoma. Am J Surg. 2006;192:46–51.CrossRefPubMed Tomimaru Y, Sasaki Y, Yamada T, et al. The significance of surgical resection for pulmonary metastasis from hepatocellular carcinoma. Am J Surg. 2006;192:46–51.CrossRefPubMed
6.
Zurück zum Zitat Choi D, Lim HK, Kim MJ, et al. Recurrent hepatocellular carcinoma: percutaneous radiofrequency ablation after hepatectomy. Radiology. 2004;230:135–41.CrossRefPubMed Choi D, Lim HK, Kim MJ, et al. Recurrent hepatocellular carcinoma: percutaneous radiofrequency ablation after hepatectomy. Radiology. 2004;230:135–41.CrossRefPubMed
7.
Zurück zum Zitat Marelli L, Stigliano R, Triantos C, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol. 2007;30:6–25.CrossRefPubMed Marelli L, Stigliano R, Triantos C, et al. Transarterial therapy for hepatocellular carcinoma: which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol. 2007;30:6–25.CrossRefPubMed
8.
Zurück zum Zitat Vauthey JN, Klimstra D, Franceschi D, et al. Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg. 1995;169:28–34.CrossRefPubMed Vauthey JN, Klimstra D, Franceschi D, et al. Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg. 1995;169:28–34.CrossRefPubMed
9.
Zurück zum Zitat Poon RT, Fan ST, O’Suilleabhain CB, Wong J. Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg. 2002;195:311–8.CrossRefPubMed Poon RT, Fan ST, O’Suilleabhain CB, Wong J. Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg. 2002;195:311–8.CrossRefPubMed
10.
Zurück zum Zitat Ikai I, Arii S, Kojiro M, et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer. 2004;101:796–802.CrossRefPubMed Ikai I, Arii S, Kojiro M, et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer. 2004;101:796–802.CrossRefPubMed
11.
Zurück zum Zitat Koide N, Kondo H, Suzuki K, et al. Surgical treatment of pulmonary metastasis from hepatocellular carcinoma. Hepatogastroenterology. 2007;54:152–6.PubMed Koide N, Kondo H, Suzuki K, et al. Surgical treatment of pulmonary metastasis from hepatocellular carcinoma. Hepatogastroenterology. 2007;54:152–6.PubMed
12.
Zurück zum Zitat Schneider T, Warth A, Herpel E, et al. Intraoperative radiofrequency ablation of lung metastases and histologic evaluation. Ann Thorac Surg. 2009;87:379–84.CrossRefPubMed Schneider T, Warth A, Herpel E, et al. Intraoperative radiofrequency ablation of lung metastases and histologic evaluation. Ann Thorac Surg. 2009;87:379–84.CrossRefPubMed
13.
Zurück zum Zitat Nakagawa T, Kamiyama T, Nakanishi K, et al. Pulmonary resection for metastases from hepatocellular carcinoma: factors influencing prognosis. J Thorac Cardiovasc Surg. 2006;131:1248–54.CrossRefPubMed Nakagawa T, Kamiyama T, Nakanishi K, et al. Pulmonary resection for metastases from hepatocellular carcinoma: factors influencing prognosis. J Thorac Cardiovasc Surg. 2006;131:1248–54.CrossRefPubMed
14.
Zurück zum Zitat Kuo SW, Chang YL, Huang PM, et al. Prognostic factors for pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol. 2007;14:992–7.CrossRefPubMed Kuo SW, Chang YL, Huang PM, et al. Prognostic factors for pulmonary metastasectomy in hepatocellular carcinoma. Ann Surg Oncol. 2007;14:992–7.CrossRefPubMed
15.
Zurück zum Zitat Aramaki M, Kawano K, Kai T, et al. Treatment for extrahepatic metastasis of hepatocellular carcinoma following successful hepatic resection. Hepatogastroenterology. 1999;46:2931–4.PubMed Aramaki M, Kawano K, Kai T, et al. Treatment for extrahepatic metastasis of hepatocellular carcinoma following successful hepatic resection. Hepatogastroenterology. 1999;46:2931–4.PubMed
16.
Zurück zum Zitat Okusaka T, Okada S, Ishii H, et al. Prognosis of hepatocellular carcinoma patients with extrahepatic metastases. Hepatogastroenterology. 1997;44:251–7.PubMed Okusaka T, Okada S, Ishii H, et al. Prognosis of hepatocellular carcinoma patients with extrahepatic metastases. Hepatogastroenterology. 1997;44:251–7.PubMed
17.
Zurück zum Zitat Cheng AL, Yeh KH, Fine RL, et al. Biochemical modulation of doxorubicin by high-dose tamoxifen in the treatment of advanced hepatocellular carcinoma. Hepatogastroenterology. 1998;45:1955–60.PubMed Cheng AL, Yeh KH, Fine RL, et al. Biochemical modulation of doxorubicin by high-dose tamoxifen in the treatment of advanced hepatocellular carcinoma. Hepatogastroenterology. 1998;45:1955–60.PubMed
18.
Zurück zum Zitat Lam CM, Lo CM, Yuen WK, Liu CL, Fan ST. Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma. Br J Surg. 1998;85:1198–200.CrossRefPubMed Lam CM, Lo CM, Yuen WK, Liu CL, Fan ST. Prolonged survival in selected patients following surgical resection for pulmonary metastasis from hepatocellular carcinoma. Br J Surg. 1998;85:1198–200.CrossRefPubMed
19.
Zurück zum Zitat Pfannschmidt J, Bischoff M, Muley T, et al. Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques. Thorac Cardiovasc Surg. 2008;56:471–5.CrossRefPubMed Pfannschmidt J, Bischoff M, Muley T, et al. Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques. Thorac Cardiovasc Surg. 2008;56:471–5.CrossRefPubMed
20.
Zurück zum Zitat McCormack PM, Bains MS, Begg CB, et al. Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial. Ann Thorac Surg. 1996;62:213–6.CrossRefPubMed McCormack PM, Bains MS, Begg CB, et al. Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial. Ann Thorac Surg. 1996;62:213–6.CrossRefPubMed
21.
Zurück zum Zitat Chan SL, Mo FK, Johnson PJ, et al. New utility of an old marker: serial alpha-fetoprotein measurement in predicting radiologic response and survival of patients with hepatocellular carcinoma undergoing systemic chemotherapy. J Clin Oncol. 2009;27:446–52.CrossRefPubMed Chan SL, Mo FK, Johnson PJ, et al. New utility of an old marker: serial alpha-fetoprotein measurement in predicting radiologic response and survival of patients with hepatocellular carcinoma undergoing systemic chemotherapy. J Clin Oncol. 2009;27:446–52.CrossRefPubMed
22.
Zurück zum Zitat Kawamura M, Nakajima J, Matsuguma H, et al. Surgical outcomes for pulmonary metastases from hepatocellular carcinoma. Eur J Cardiothorac Surg. 2008;34:196–9.CrossRefPubMed Kawamura M, Nakajima J, Matsuguma H, et al. Surgical outcomes for pulmonary metastases from hepatocellular carcinoma. Eur J Cardiothorac Surg. 2008;34:196–9.CrossRefPubMed
23.
Zurück zum Zitat Chen F, Sato K, Fujinaga T, et al. Pulmonary resection for metastases from hepatocellular carcinoma. World J Surg. 2008;32:2213–7.CrossRefPubMed Chen F, Sato K, Fujinaga T, et al. Pulmonary resection for metastases from hepatocellular carcinoma. World J Surg. 2008;32:2213–7.CrossRefPubMed
24.
Zurück zum Zitat Kwon JB, Park K, Kim YD, et al. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors. World J Gastroenterol. 2008;14:5717–22.CrossRefPubMed Kwon JB, Park K, Kim YD, et al. Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors. World J Gastroenterol. 2008;14:5717–22.CrossRefPubMed
Metadaten
Titel
Long-Term Survival and Prognostic Factors after Pulmonary Metastasectomy in Hepatocellular Carcinoma
verfasst von
Yoo Sang Yoon, MD
Hong Kwan Kim, MD
Jhingook Kim, MD, PhD
Yong Soo Choi, MD
Young Mog Shim, MD, PhD
Seung Woon Paik, MD
Kwhanmien Kim, MD, PhD
Publikationsdatum
01.10.2010
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 10/2010
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1073-5

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