Prognostic factors for pulmonary metastasectomy in hepatocellular carcinoma

Abstract

Purpose: To identify the prognostic factors for pulmonary metastasectomy (PM-ectomy) in hepatocellular carcinoma (HCC).

Patients and methods: We conducted a retrospective review of patients with pulmonary metastases (PM) from HCC who had undergone curative PM-ectomy at National Taiwan University Hospital between 1990 and 2004. Univariate (log-rank) and multivariate (Cox's model) analyses of survival were used to identify the significant prognostic factors.

Results: In total, 34 patients were eligible for curative PM-ectomy. The overall survival rates (Kaplan-Meier) after PM-ectomy were 65.2% and 27.5% at 2 and 5 years, respectively. High alpha-fetoprotein level, positive hepatic resection margin, and short disease-free interval (DFI) were unfavorable factors for overall survival from univariate analysis, however, only DFI (P = 0.028) was identified as an independently prognostic factor by multivariate analysis. Bilateral distribution and more PMs were unfavorable factors for PM-free survival from univariate analysis, with only PM number identified as an independent prognostic factor by multivariate analysis (P = 0.017).

Conclusion: Patients with longer DFIs and fewer PMs can benefit from PM-ectomy in HCC.

FIG. 1.

Overall survival in relation to disease-free interval (DFI). Longer DFI was associated with significantly longer survival (P = 0.011).

FIG. 2.

Pulmonary metastases (PM)-free survival with relation to PM number. Larger PM number was associated with significantly shorter PM-free survival (P < 0.001).