Hee Chul Nam1,2, Pil Soo Sung1,2, Do Seon Song2, Jung Hyun Kwon2,3, Soon Woo Nam2,3, Dong Jin Yoon1, Jeong Won Jang1,2, Jong Young Choi1,2, Seung Kew Yoon1,2, Seok Whan Moon4, Hong Seok Jang5, Jae-Sung Park6, Sin-Soo Jeun6, Yong-Kil Hong6, Si Hyun Bae7,8. 1. Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. 2. The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 3. Department of Internal Medicine, College of Medicine, Incheon St. Mary's hospital, The Catholic University of Korea, Seoul, South Korea. 4. Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. 5. Department of Radiation Oncology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. 6. Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. 7. The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea. baesh@catholic.ac.kr. 8. Department of Internal Medicine, College of Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, South Korea. baesh@catholic.ac.kr.
Abstract
BACKGROUND: Brain metastasis is a rare event in patients with hepatocellular carcinoma (HCC). This retrospective study aimed to identify the prognostic factors and determine the outcomes of patients with brain metastases from HCC. METHODS: About 86 patients with brain metastases (0.6%) from HCC were identified from two institutions; of them, 32 underwent tumor-removing surgery or stereotactic radiosurgery (SRS) with or without adjuvant whole brain radiotherapy (WBRT) (group 1), 30 had WBRT alone (group 2), and 24 received conservative treatment (group 3). Estimates for overall survival (OS) after brain metastases were determined, and clinical prognostic factors were identified. RESULTS: The median OS after development of brain metastases was 50 days. About 75 (87.2%) patients had lung metastases at the time of brain metastasis diagnosis. Group 1 showed better OS, followed by group 2 and group 3, sequentially (p < 0.001). Univariate analyses showed that treatment with curative intent (surgery or SRS), Child-Pugh class A, alpha-fetoprotein level < 400 ng/ml, and recursive partitioning analysis classification I or II were associated with improved survival (p < 0.001, 0.002, 0.029, and 0.012, respectively). Multivariate analysis showed that treatment with curative intent and Child-Pugh class A was associated with improved OS (p < 0.001 and 0.009, respectively). CONCLUSION: Although the overall prognosis of patients with brain metastases from HCC is extremely poor, patients actively treated with surgery or radiosurgery have prolonged survival, suggesting that interventions to control intracranial disease are important in these patients.
BACKGROUND: Brain metastasis is a rare event in patients with hepatocellular carcinoma (HCC). This retrospective study aimed to identify the prognostic factors and determine the outcomes of patients with brain metastases from HCC. METHODS: About 86 patients with brain metastases (0.6%) from HCC were identified from two institutions; of them, 32 underwent tumor-removing surgery or stereotactic radiosurgery (SRS) with or without adjuvant whole brain radiotherapy (WBRT) (group 1), 30 had WBRT alone (group 2), and 24 received conservative treatment (group 3). Estimates for overall survival (OS) after brain metastases were determined, and clinical prognostic factors were identified. RESULTS: The median OS after development of brain metastases was 50 days. About 75 (87.2%) patients had lung metastases at the time of brain metastasis diagnosis. Group 1 showed better OS, followed by group 2 and group 3, sequentially (p < 0.001). Univariate analyses showed that treatment with curative intent (surgery or SRS), Child-Pugh class A, alpha-fetoprotein level < 400 ng/ml, and recursive partitioning analysis classification I or II were associated with improved survival (p < 0.001, 0.002, 0.029, and 0.012, respectively). Multivariate analysis showed that treatment with curative intent and Child-Pugh class A was associated with improved OS (p < 0.001 and 0.009, respectively). CONCLUSION: Although the overall prognosis of patients with brain metastases from HCC is extremely poor, patients actively treated with surgery or radiosurgery have prolonged survival, suggesting that interventions to control intracranial disease are important in these patients.
Authors: U Harmenberg; M Lindskog; G Sinclair; M Stenman; H Benmakhlouf; P Wersäll; P Johnstone; M A Hatiboglu; J Mayer-da-Silva Journal: Acta Neurochir (Wien) Date: 2020-09-09 Impact factor: 2.216