Extrahepatic metastases occur in a minority of hepatocellular carcinoma patients treated with locoregional therapies

Analyzing patterns of progression in 285 patients

Seanthan Senthilnathan, Khairuddin Memon, Robert J. Lewandowski, Laura Kulik, Mary F. Mulcahy, Ahsun Riaz, Frank H. Miller, Vahid Yaghmai, Paul Nikolaidis, Edward Wang, Talia Baker, Michael Abecassis, Al B. Benson, Reed A. Omary, Riad Salem*

*Corresponding author for this work

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Although most cancers are considered predominantly systemic processes, this may not hold true for hepatocellular carcinoma (HCC). The literature regarding patterns of progression of HCC (local versus systemic) has been relatively sparse. Our objectives were to: (1) analyze patterns of progression in HCC patients presenting with intrahepatic disease from initial treatment until death, and (2) identify clinically relevant risk factors for the development of metastases. Over a 9-year period, 285 patients treated with transarterial locoregional therapies underwent scheduled imaging follow-up from treatment until death and were categorized by pattern of progression: (i) intrahepatic (increased tumor enhancement/size, development/progression of vascular invasion, new hepatic lesions) progression or (ii) extrahepatic (adrenal/bone/lung/lymph node) metastases. Uni/multivariate analyses assessing the risk factors for the development of metastases were performed. The median time from last scan to death was 2.4 months (interquartile range: 1.3-4.8 months). The time to development of metastases, vascular invasion, and/or new lesions was 13.8 months (confidence interval: 11.3-17.7 months). Of the 209 patients followed until death, only 50 developed extrahepatic metastases (24%). Multivariate analyses identified age <65 years (P = 0.038), alpha-fetoprotein >200 ng/mL (P = 0.04), and vascular invasion (P = 0.017) as significant predictors of metastases development. Conclusion: Knowledge of the risk factors associated with the development of metastases may help guide assessment of patient prognosis. Because 76% of patients presenting with local disease treated with locoregional therapies die without developing extrahepatic metastases, the notion of HCC as a systemic disease, as detected by imaging, may be reconsidered.

Original languageEnglish (US)
Pages (from-to)1432-1442
Number of pages11
JournalHepatology
Volume55
Issue number5
DOIs
StatePublished - May 1 2012

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Hepatocellular Carcinoma
Neoplasm Metastasis
Blood Vessels
Therapeutics
Multivariate Analysis
Neoplasms
Lymph Nodes
Confidence Intervals
Bone and Bones
Lung
Liver

ASJC Scopus subject areas

  • Hepatology

Cite this

@article{34b1cf87722a4b2dbc0ed77598affadc,
title = "Extrahepatic metastases occur in a minority of hepatocellular carcinoma patients treated with locoregional therapies: Analyzing patterns of progression in 285 patients",
abstract = "Although most cancers are considered predominantly systemic processes, this may not hold true for hepatocellular carcinoma (HCC). The literature regarding patterns of progression of HCC (local versus systemic) has been relatively sparse. Our objectives were to: (1) analyze patterns of progression in HCC patients presenting with intrahepatic disease from initial treatment until death, and (2) identify clinically relevant risk factors for the development of metastases. Over a 9-year period, 285 patients treated with transarterial locoregional therapies underwent scheduled imaging follow-up from treatment until death and were categorized by pattern of progression: (i) intrahepatic (increased tumor enhancement/size, development/progression of vascular invasion, new hepatic lesions) progression or (ii) extrahepatic (adrenal/bone/lung/lymph node) metastases. Uni/multivariate analyses assessing the risk factors for the development of metastases were performed. The median time from last scan to death was 2.4 months (interquartile range: 1.3-4.8 months). The time to development of metastases, vascular invasion, and/or new lesions was 13.8 months (confidence interval: 11.3-17.7 months). Of the 209 patients followed until death, only 50 developed extrahepatic metastases (24{\%}). Multivariate analyses identified age <65 years (P = 0.038), alpha-fetoprotein >200 ng/mL (P = 0.04), and vascular invasion (P = 0.017) as significant predictors of metastases development. Conclusion: Knowledge of the risk factors associated with the development of metastases may help guide assessment of patient prognosis. Because 76{\%} of patients presenting with local disease treated with locoregional therapies die without developing extrahepatic metastases, the notion of HCC as a systemic disease, as detected by imaging, may be reconsidered.",
author = "Seanthan Senthilnathan and Khairuddin Memon and Lewandowski, {Robert J.} and Laura Kulik and Mulcahy, {Mary F.} and Ahsun Riaz and Miller, {Frank H.} and Vahid Yaghmai and Paul Nikolaidis and Edward Wang and Talia Baker and Michael Abecassis and Benson, {Al B.} and Omary, {Reed A.} and Riad Salem",
year = "2012",
month = "5",
day = "1",
doi = "10.1002/hep.24812",
language = "English (US)",
volume = "55",
pages = "1432--1442",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
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TY - JOUR

T1 - Extrahepatic metastases occur in a minority of hepatocellular carcinoma patients treated with locoregional therapies

T2 - Analyzing patterns of progression in 285 patients

AU - Senthilnathan, Seanthan

AU - Memon, Khairuddin

AU - Lewandowski, Robert J.

AU - Kulik, Laura

AU - Mulcahy, Mary F.

AU - Riaz, Ahsun

AU - Miller, Frank H.

AU - Yaghmai, Vahid

AU - Nikolaidis, Paul

AU - Wang, Edward

AU - Baker, Talia

AU - Abecassis, Michael

AU - Benson, Al B.

AU - Omary, Reed A.

AU - Salem, Riad

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Although most cancers are considered predominantly systemic processes, this may not hold true for hepatocellular carcinoma (HCC). The literature regarding patterns of progression of HCC (local versus systemic) has been relatively sparse. Our objectives were to: (1) analyze patterns of progression in HCC patients presenting with intrahepatic disease from initial treatment until death, and (2) identify clinically relevant risk factors for the development of metastases. Over a 9-year period, 285 patients treated with transarterial locoregional therapies underwent scheduled imaging follow-up from treatment until death and were categorized by pattern of progression: (i) intrahepatic (increased tumor enhancement/size, development/progression of vascular invasion, new hepatic lesions) progression or (ii) extrahepatic (adrenal/bone/lung/lymph node) metastases. Uni/multivariate analyses assessing the risk factors for the development of metastases were performed. The median time from last scan to death was 2.4 months (interquartile range: 1.3-4.8 months). The time to development of metastases, vascular invasion, and/or new lesions was 13.8 months (confidence interval: 11.3-17.7 months). Of the 209 patients followed until death, only 50 developed extrahepatic metastases (24%). Multivariate analyses identified age <65 years (P = 0.038), alpha-fetoprotein >200 ng/mL (P = 0.04), and vascular invasion (P = 0.017) as significant predictors of metastases development. Conclusion: Knowledge of the risk factors associated with the development of metastases may help guide assessment of patient prognosis. Because 76% of patients presenting with local disease treated with locoregional therapies die without developing extrahepatic metastases, the notion of HCC as a systemic disease, as detected by imaging, may be reconsidered.

AB - Although most cancers are considered predominantly systemic processes, this may not hold true for hepatocellular carcinoma (HCC). The literature regarding patterns of progression of HCC (local versus systemic) has been relatively sparse. Our objectives were to: (1) analyze patterns of progression in HCC patients presenting with intrahepatic disease from initial treatment until death, and (2) identify clinically relevant risk factors for the development of metastases. Over a 9-year period, 285 patients treated with transarterial locoregional therapies underwent scheduled imaging follow-up from treatment until death and were categorized by pattern of progression: (i) intrahepatic (increased tumor enhancement/size, development/progression of vascular invasion, new hepatic lesions) progression or (ii) extrahepatic (adrenal/bone/lung/lymph node) metastases. Uni/multivariate analyses assessing the risk factors for the development of metastases were performed. The median time from last scan to death was 2.4 months (interquartile range: 1.3-4.8 months). The time to development of metastases, vascular invasion, and/or new lesions was 13.8 months (confidence interval: 11.3-17.7 months). Of the 209 patients followed until death, only 50 developed extrahepatic metastases (24%). Multivariate analyses identified age <65 years (P = 0.038), alpha-fetoprotein >200 ng/mL (P = 0.04), and vascular invasion (P = 0.017) as significant predictors of metastases development. Conclusion: Knowledge of the risk factors associated with the development of metastases may help guide assessment of patient prognosis. Because 76% of patients presenting with local disease treated with locoregional therapies die without developing extrahepatic metastases, the notion of HCC as a systemic disease, as detected by imaging, may be reconsidered.

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U2 - 10.1002/hep.24812

DO - 10.1002/hep.24812

M3 - Article

VL - 55

SP - 1432

EP - 1442

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 5

ER -