Therapeutic significance and indications of pulmonary metastasectomy for hepatocellular carcinoma following liver resection. (December 2017)

• Record Type: Journal Article
• Authors: Hu, Zhigang; Li, Wenbin; Huang, Pinbo; Zhou, Zhenyu; Xu, Junyao; Xu, Kang; Wang, Jie; Zhang, Heyun
• Is Part Of: International journal of surgery. Volume 48(2017)
• Page Start: 23
• Page End: 31
• Publication Date: 2017-12
• Subjects: Hepatocellular carcinoma -- Pulmonary metastasis -- Pulmonary metastasectomy -- Liver resection; PM pulmonary metastasis -- HCC hepatocellular carcinoma -- PMT pulmonary metastasectomy -- LR liver resection -- PSM propensity score matching -- OS overall survival -- AFP alpha fetal protein -- IHRM intrahepatic recurrence or metastasis -- DM distant metastasis -- ECOG Eastern Cooperative Oncology Group -- TNM Tumor Node Metastasis -- BCLC Barcelona Clinic Liver Cancer -- IHT intrahepatic treatments -- TACE transarterial chemoembolization -- ST systemic therapies -- SC supportive care -- IQR interquartile range -- CI confidential interval; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.09.075
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: To explore the therapeutic significance and indications of pulmonary metastasectomy (PMT) in hepatocellular carcinoma (HCC) patients with pulmonary metastasis (PM) following liver resection (LR). Patients and methods: PM-HCC patients who underwent LR were retrospectively enrolled, and survival outcomes and prognostic factors were analyzed. Patients were divided into PMT and non-PMT group, and propensity score matching (PSM) analysis was used for survival comparison. Prognostic analysis and survival comparisons were performed specifically in PMT patients. Results: Ninety-seven patients were enrolled, among which twenty-six underwent PMT while seventy-one did not. Survival outcome was superior in PMT group compared to non-PMT group (33.5 vs. 10.5 months) (p = 0.003), while no statistical difference was found after PSM analysis (33.5 vs. 11.2 months) (p = 0.138). Synchronous PM-HCC, serum alpha fetal protein≥400 ng/ml at PM diagnosis, no intrahepatic treatments (LR, ablation or transarterial chemoembolization) after LR, intrahepatic recurrence or metastasis at repeated PM diagnosis were inferior independent prognostic factors in PMT patients (p < 0.05). Superior survival outcomes were seen in candidate PMT patients when corresponding indications were satisfied (p = 0.014, p = 0.005). Conclusion: PMT might provide potential survival benefits in well selected PM-HCC patients who underwent LR. Well designed, multi-institutional studies with larger patient number were still to be required. Highlights: PM-HCC patients might acquire superior prognosis when intrahepatic tumors were controlled by LR. PMT might provide potential survival benefits in well selected PM-HCC patients. Synchronous PM-HCC, AFP≥400 ng/ml, no IHT after LR, IHRM when PM repeated were inferior independent prognostic factors. Well designed, multi-institutional studies with larger patient number were needed.