Abstract
ObjectiveTo develop a prognostic model for overall survival (OS) in hepatocellular carcinoma (HCC) patients receiving radiotherapy (RT) to metastatic abdominal lymph nodes (LNs).Materials and MethodsTwo hundred twenty-eight patients treated with RT to metastatic abdominal LNs were retrospectively reviewed.ResultsMedian OS in all patients was 11.1 months. LN responders had significantly higher median OS than non-responders (14.2 months vs. 7.5 months, p<0.05). On multivariate analysis, Child-Pugh classification, status of intrahepatic tumor, presence of distant metastasis, number and location of metastatic LNs, serum level of alpha fetoprotein (AFP), and the LN response to RT were significant prognostic factors for OS (p < 0.05 each). Based on the results of multivariate analysis, prognostic group stratification according to the number of pre-treatment risk factors was a significant predictor of OS, and median OS in patients with ≥ 4, 3, 2, 1, and 0 risk factors were 2.9, 5.5, 10.3, 13.6, and 27.8 months, respectively (p<0.05). A nomogram was formulated by integrating the different prognostic contribution of each factor, and it showed good accuracy for predicting 2-year OS with a concordance index of 0.72.ConclusionPrognostic group stratification and nomogram could be useful prognostic and therapeutic indicators in selecting treatment strategies.
Highlights
Abdominal lymph node (LN) is a frequent site of extrahepatic metastasis from hepatocellular carcinoma (HCC), along with lung and bone [1,2,3,4], with a reported incidence of 25 to 42% in several autopsy series [2, 4], and it is associated with poor prognosis
Based on the results of multivariate analysis, prognostic group stratification according to the number of pre-treatment risk factors was a significant predictor of overall survival (OS), and median OS in patients with ≥ 4, 3, 2, 1, and 0 risk factors were 2.9, 5.5, 10.3, 13.6, and 27.8 months, respectively (p
A nomogram was formulated by integrating the different prognostic contribution of each factor, and it showed good accuracy for predicting 2-year OS with a concordance index of 0.72
Summary
Abdominal lymph node (LN) is a frequent site of extrahepatic metastasis from hepatocellular carcinoma (HCC), along with lung and bone [1,2,3,4], with a reported incidence of 25 to 42% in several autopsy series [2, 4], and it is associated with poor prognosis. With advances in diagnostic imaging technology and improvements of www.impactjournals.com/oncotarget intrahepatic tumor control by effective local treatments, abdominal LN metastasis from HCC may become more frequent in clinical situations Various treatment modalities, such as surgical resection, transcatheter arterial chemoembolization, radiofrequency ablation, and percutaneous ethanol injection, have not been considered as an option in most cases due to the presence of intraand extrahepatic tumors and/or poor hepatic function, insufficiency of blood supply, and the closeness of the gastrointestinal organs, respectively [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. We performed this retrospective multi-institutional study with subjects obtained from four institutions of the Korean Radiation Oncology Group (KROG) to analyze the effects of pretreatment tumor and patient factors on clinical outcomes in HCC patients who underwent RT to treat metastatic abdominal LN(s) and to identify prognostic and therapeutic indicators in these patients for developing the prognostic model to predict survival
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