Extrahepatic spread from hepatocellular carcinoma: Who are candidates for aggressive anti-cancer treatment?

Background: There is no standard treatment for patients with extrahepatic spread from hepatocellular carcinoma. The aim of this retrospective study was to identify candidates for aggressive intervention or new drug trial among such patients. Methods: Retrospective exploration was performed to extract a patient cohort step by step using univariate and multivariate analyses. Results: There were 201 subjects from the past 12 years. The 1-, 3- and 5-year survival rates were 31.0, 9.2 and 4.5%, respectively. The upper limit of the 95% confidence interval of median survival time did not reach 3 months in patients with a performance status of 2 or worse, or with Child-Pugh grades B or C. After excluding those, univariate and multivariate analyses were performed in the remaining 124 subjects. Three independent prognostic factors-brain metastasis. number of metastatic tumors and primary tumor status-were identified. The final cohort was set at 121 after excluding three with brain metastasis. Among these 121, there were 11 with a solitary metastatic tumor and T1/2 primary tumor. In this subgroup, 10 underwent complete removal of the metastatic tumor, and the median survival time exceeded 5 years. Conclusion: Candidates for anti-cancer treatment should meet the following requirements: a performance status of 0 or 1, a Child-Pugh grade A and no brain metastasis. Among these, challenging locoregional intervention was acceptable only for patients with solitary metastatic tumor and T1/2 primary tumor.