Association of hepatocellular carcinoma in North American patients with extrahepatic primary malignancies

Abstract

Background: The finding of an association between one primary tumor and others is an area of continuing interest from clinical and pathologic viewpoints. The authors studied patients in North America with hepatocellular carcinoma associated with extrahepatic primary malignancies (EHPMs) and compared them with patients who had hepatocellular carcinomas not associated with other neoplasms. The authors know of only four other series that have investigated such cases, none of which was from North America.

Methods: The authors retrospectively reviewed 1349 consecutive cases of histologically diagnosed hepatocellular carcinoma (HCC) at the Armed Forces Institute of Pathology over a 14-year period. Seventy-four patients (5.5%) had an EHPM, and these were compared with the 1275 patients who did not have another primary malignancy. Statistical comparisons were made using the chi-square statistical or Fisher's exact test, as appropriate, and life-table survival analyses were performed.

Results: Significantly more men (P = 0.02) than women had EHPMs, and their mean age of 69.2 +/- 2.1 years was significantly older (P < 0.05) than that of those without EHPMs (59.9 +/- 1.0 years). Seventeen (19.8%) EHPMs occurred before HCC, 66 (76.7%) occurred synchronously, and 3 (3.5%) occurred metachronously. The probability of finding an EHPM increased if the nonneoplastic liver was cirrhotic or dysplastic. Mean survival for the HCC with EHPM group did not differ significantly from that for the group without EHPM.

Conclusions: Extrahepatic primary malignancies do not significantly influence the survival of patients with HCC. The most common EHPMs associated with HCC are either diseases of old age or those already known to be common among North American populations.