Background
Methods
Patients
Methods
Statistical analysis
Results
Prevalence and clinical characteristics of EHPM in patients with HCC
Variables | non-EHPM group (n = 217) | EHPM group (n = 33) | p-value |
---|---|---|---|
Age, yearsa, † | 55.1 ± 11.1 | 63.1 ± 10.6 | <0.001* |
Male sexb | 168 (77.4) | 25 (75.8) | 0.832 |
Diabetes mellitusb | 36 (16.6) | 12 (36.4) | 0.007* |
Hypertensionb | 60 (27.6) | 16 (48.5) | 0.015* |
Coexisting cirrhosisb | 126 (58.1) | 21 (63.6) | 0.545 |
Etiology of liver diseaseb | <0.001* | ||
HBsAg (+) | 167 (77.0) | 16( 48.5) | |
Anti-HCV (+) | 19 (8.8) | 2 (6.1) | |
Alcohol | 9 (4.1) | 6 (18.8) | |
Other | 22 (10.1) | 9 (27.30) | |
CTP scoreb | 1.000 | ||
A | 206 (94.9) | 32 (97.0) | |
B | 11 (5.1) | 1 (3.0) | |
MELD scorea | 6.1 ± 3.4 | 5.4 ± 3.3 | 0.210 |
AST (IU/L)a | 54.9 ± 74.1 | 33.6 ± 13.8 | 0.024* |
ALT (IU/L)a | 55.8 ± 90.1 | 31.3 ± 17.4 | 0.016* |
Total bilirubin (mg/dL)a | 1.5 ± 7.1 | 0.7 ± 0.3 | 0.020* |
Serum albumin (g/dL)a | 4.0 ± 0.5 | 3.9 ± 0.5 | 0.126 |
Platelet count (×103/μL)a | 162.7 ± 72.7 | 171.2 ± 65.6 | 0.439 |
APRI scorea | 1.1 ± 1.4 | 0.6 ± 0.3 | 0.034* |
AFP (ng/mL)b | 0.149 | ||
<20 | 109 (50.9) | 20 (64.5) | |
20–200 | 41 (19.2) | 5 (16.1) | |
>200b | 64 (29.9) | 6 (19.4) | |
pTNM stage of HCCb | 0.259 | ||
I | 106 (40.8) | 19 (57.6) | |
II | 77 (35.5) | 11 (33.3) | |
III or IV | 34 (15.7) | 3(9.1) | |
Portal vein or major vessel invasionb | 11 (5.1) | 3 (9.1) | 0.406 |
Microvessel invasionb | 86 (39.6) | 12 (36.4) | 0.720 |
Tumor sizea | 4.2 ± 2.8 | 3.8 ± 2.5 | 0.477 |
Follow-up duration (months)a | 48.5 ± 26.2 | 36.0 ± 30.0 | 0.013* |
Overall median survival (months) | 46.0 | 27.0 | 0.178 |
HCC recurrenceb | 114 (52.5) | 10 (30.3) | 0.017* |
Time to recurrence (months)a | 17.8 ± 16.8 | 21.4 ± 17.5 | 0.548 |
Number of deathsb | 54 (24.9) | 11 (33.3) | 0.303 |
Time to death (months)a | 29.8 ± 22.6 | 15.2 ± 15.3 | 0.045* |
Cause of deathb | 0.005* | ||
Liver-related | 50 (92.6) | 6 (54.5) | |
Other | 4 (7.4) | 5 (45.5) |
Variables | Prior†EHPM group (n = 7) | Synchronous†EHPM group (n = 17) | Metachronous†EHPM group (n = 9) | Total (n = 33) | p-value |
---|---|---|---|---|---|
Age, yearsa, ‡ | 64.3 ± 2.6 | 62.5 ± 2.8 | 63.3 ± 4.2 | 63.1 ± 1.8 | 0.936 |
Male sexb | 4 (57.1) | 14 (82.4) | 7 (77.8) | 25 (75.8) | 0.487 |
Smoking, >10 pack-yearsb | 3 (42.9) | 6 (35.3) | 3 (37.5) | 12 (37.5) | 1.000 |
Etiology of liver diseaseb | 0.471 | ||||
HBsAg (+) | 5 (71.4) | 6 (35.3) | 5 (55.6) | 16 (48.5) | |
Anti-HCV (+) | 1 (14.3) | 1(5.9) | 0 (0.0) | 2 (6.1) | |
Alcohol | 0 (0.0) | 5(29.4) | 1 (11.1) | 6 (18.2) | |
Other | 1 (14.3) | 5(29.4) | 3 (33.3) | 9 (27.3) | |
CTP scoreb | 0.212 | ||||
A | 6 (85.7) | 17 (100.0) | 9 (100.0) | 32 (97.0) | |
B | 1 (14.3) | 0 (0.0) | 0 (0.0) | 1 (3.0) | |
pTNM stage of HCCb | 0.191 | ||||
I | 2 (28.6) | 12 (70.6) | 5 (55.6) | 19 (57.6) | |
II | 4 (57.1) | 3 (17.6) | 4 (44.4) | 11 (33.3) | |
III or IV | 1 (14.3) | 2 (11.8) | 0 (0.0) | 3 (9.1) | |
AFP (ng/mL)b | 0.470 | ||||
<20 | 5 (71.4) | 11 (68.8) | 4 (50.0) | 20 (64.5) | |
20–200 | 0 (0.0) | 2 (12.5) | 3 (37.5) | 5 (16.1) | |
>200 | 2 (28.6) | 3 (18.8) | 1 (12.5) | 6 (19.4) | |
Location of EHPMb | |||||
Esophagus | 0 (0.0) | 1 (5.9) | 0 (0.0) | 1 (3.0) | 1.000 |
Stomach | 4 (57.1) | 4 (23.5) | 1 (11.1) | 9 (27.3) | 0.152 |
Colorectal | 1 (14.3) | 6 (35.3) | 3 (33.3) | 10 (30.3) | 0.697 |
Pancreas | 0 (0.0) | 0 (0.0) | 1 (11.1) | 1 (3.0) | 0.485 |
Common bile duct | 0 (0.0) | 0 (0.0) | 1 (11.1) | 1 (3.0) | 0.485 |
Breast | 2 (28.6) | 2 (11.8) | 0 (0.0) | 4 (12.1) | 0.222 |
Thyroid | 0 (0.0) | 0 (0.0) | 1 (11.1) | 1 (3.0) | 0.485 |
Kidney | 1 (14.3) | 2 (11.8) | 0 (0.0) | 3 (9.1) | 0.579 |
Bladder | 0 (0.0) | 0 (0.0) | 1 (11.1) | 1 (3.0) | 0.485 |
Prostate | 0 (0.0) | 0 (0.0) | 1 (11.1) | 1 (3.0) | 0.485 |
Retroperitoneum | 0 (0.0) | 1 (5.9) | 0 (0.0) | 1 (3.0) | 1.000 |
Bone marrow | 0 (0.0) | 1 (5.9) | 0 (0.0) | 1 (3.0) | 1.000 |
pTNM stage of EHPM | 0.166 | ||||
0 | 0 (0.0) | 1 (5.9) | 0 (0.0) | 1 (3.3) | |
1 | 4 (80.0) | 8 (47.1) | 1 (12.5) | 13 (43.3) | |
2 | 1 (20.0) | 4 (23.5) | 1 (12.5) | 6 (20.0) | |
3 | 0 (0.0) | 3 (17.6) | 5 (62.5) | 8 (26.7) | |
4 | 0 (0.0) | 1 (5.9) | 1 (12.5) | 2 (6.7) | |
Treatment of EHPMb | 1.000 | ||||
Operation | 7 (100.0) | 14 (82.4) | 7 (77.8) | 28 (84.8) | |
Radiation or Chemotherapy | 0 (0.0) | 1 (5.9) | 1 (11.1) | 2 (6.1) | |
Supportive care | 0 (0.0) | 2 (11.8) | 1 (11.1) | 3 (9.1) | |
Progression or recurrence of EHPMb | 0 (0.0) | 6 (35.3) | 3 (33.3) | 9 (27.3) | 0.221 |
Follow-up duration (months)a | 18.4 ± 5.9 | 35.9 ± 6.7 | 49.8 ± 12.5 | 36.0 ± 5.2 | 0.115 |
Overall median survival (months) | 18.0 | 32.0 | 38.0 | 28.0 | |
Recurrence of HCCb | 3 (42.9) | 5 (29.4) | 2 (22.2) | 10 (30.3) | 0.781 |
Deathb | 2 (28.6) | 7 (41.2) | 2 (22.2) | 11 (33.3) | 0.628 |
Cause of deathb | 0.697 | ||||
Liver-related | 1 (50.0) | 3 (42.9) | 2 (100.0) | 6 (100.0) | |
Other | 1 (50.0) | 4 (57.1) | 0 (0.0) | 5 (100.0) |
Case number | EHPM site | EHPM groupa | pTNM stage† | Follow up or survival duration (months) | Cause of deathb | |||
---|---|---|---|---|---|---|---|---|
T | N | M | Stage | |||||
1 | Rectum | S | 3 | 0 | 0 | IIA | 118 | |
2* | Breast | S | 1 | 0 | 0 | IA | 4 | H |
3* | Stomach | S | 3 | 3 | 1 | IV | 10 | E |
4* | Stomach | S | 1 | 0 | 0 | IA | 21 | E and O |
5 | Breast | S | 1 | 0 | 0 | IA | 53 | |
6* | Kidney | S | 1 | 0 | 0 | I | 0 | H |
7* | Rectum | S | 3 | 2 | 0 | IIIB | 12 | H |
8 | Esophagus | S | 1 | 0 | 0 | IA | 52 | |
9 | Kidney | S | 1 | 0 | 0 | I | 51 | |
10 | Colon | S | 3 | 0 | 0 | IIA | 48 | |
11 | Stomach (MALToma) | S | IEA(Ann Arbor) | 47 | ||||
12 | Colon | S | 3 | 0 | 0 | IIA | 32 | |
13 | Colon | S | 3 | 0 | 0 | IIA | 28 | |
14 | Retroperitoneum | S | 2b | 0 | 0 | Ib | 35 | |
15* | Multiple myeloma | S | III(ISS) | 23 | E | |||
16 | Stomach | S | is | 0 | 0 | 0 | 17 | |
17* | Rectum | S | 3 | 1 | 0 | IIIB | 4 | O |
18* | Rectum | S | 4b | 2b | 0 | IIIC | 3 | H and E |
19* | Stomach | M | 3 | 0 | 0 | IIA | 16 | H |
20* | Kidney | P | NA | 18 | H | |||
21 | Pancreas | M | 3 | 1 | 0 | IIIB | 55 | |
22 | Prostate | M | 3 | 0 | 0 | III | 74 | |
23 | Breast | P | 2 | 0 | 0 | IIA | 46 | |
24 | Colon | P | 2 | 0 | 0 | I | 27 | |
Stomach | P | 1b | 0 | 0 | IA | |||
25 | Colon | M | 3 | 0 | 1 | IVA | 38 | |
26 | Colon | M | NA | 24 | ||||
27 | Thyroid | M | 3 | 1a | 0 | III | 29 | |
28 | CBD | M | 4 | 1 | 0 | III | 109 | |
29 | Stomach | P | 1 | 0 | 0 | IA | 17 | |
30 | Stomach | P | NA | 0 | ||||
31* | Breast | P | 1 | 0 | 0 | IA | 1 | O |
32 | Stomach | P | 1 | 0 | 0 | IA | 20 | |
33 | Bladder | M. | 1 | 0 | 0 | I | 100 |
Clinical outcomes of patients with HCC and EHPM
Variables | Univariate analysis† | Multivariate analysis† | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p value | HR | 95% CI | p-value | |
Age > 60 years | 0.967 | 0.578–1.616 | 0.897 | |||
Male sex | 0.777 | 0.394–1.533 | 0.468 | |||
Diabetes mellitus | 1.602 | 0.880–2.916 | 0.123 | |||
Hypertension | 1.172 | 0.699–1.965 | 0.547 | |||
Alcohol drinking | 0.676 | 0.405–1.128 | 0.134 | |||
Smoking, >10 pack-years | 1.069 | 0.643–1.777 | 0.796 | |||
Portal vein or major vessel invasion | 3.073 | 1.317–7.172 | 0.009* | 1.066 | 0.361–3.151 | 0.908 |
Microvessel invasion | 1.983 | 1.188–3.310 | 0.009* | 1.850 | 1.058–3.236 | 0.031* |
Intrahepatic metastasis | 1.609 | 0.923–2.804 | 0.094 | |||
Alpha-fetoprotein > 20 ng/mL | 1.806 | 1.083–3.014 | 0.043* | 1.716 | 1.018–2.892 | 0.043* |
Child-Turcotte-Pugh score B or C | 0.840 | 0.361–1.955 | 0.686 | |||
Presence of EHPM | 2.125 | 1.087–4.155 | 0.028* | 2.002 | 1.016–3.942 | 0.045* |
pTNM stage > II | 2.303 | 1.285–4.129 | 0.005* | 1.784 | 0.950–3.351 | 0.072 |