Abstract
BackgroundThe role of surgical intervention as a treatment for pulmonary metastasis (PM) from hepatocellular carcinoma (HCC) has not been established. In this study, we investigated the clinical outcomes of pulmonary metastasectomy. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method.MethodsA total of 134 patients (115 men) underwent pulmonary metastasectomy for isolated PM of HCC between January 1998 and December 2010 at Seoul Asan Medical Center. Of these, 84 underwent VATS (VATS group) and 50 underwent thoracotomy or sternotomy (open group). PSM analysis between the groups was used to match them based on the baseline characteristics of the patients.ResultsDuring the median follow-up period of 33.4 months (range, 1.8–112.0), 113 patients (84.3%) experienced recurrence, and 100 patients (74.6%) died of disease progression. There were no overall survival rate, disease-free survival rate, and pulmonary-specific disease-free survival rate differences between the VATS and the open groups (p = 0.521, 0.702, and 0.668, respectively). Multivariate analysis revealed local recurrence of HCC, history of liver cirrhosis, and preoperative alpha-fetoprotein level as independent prognostic factors for overall survival (hazard ratio, 1.729/2.495/2.632, 95% confidence interval 1.142–2.619/1.571–3.963/1.554–4.456; p = 0.010/< 0.001/< 0.001, respectively).ConclusionsMetastasectomy can be considered a potential alternative for selected patients. VATS metastasectomy had outcomes comparable to those of open metastasectomy.
Highlights
Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in Asia, including Korea [1], and ranks third in cancer deaths worldwide [2]
The results of the multinational, randomized, placebo-controlled, phase III sorafenib hepatocellular carcinoma (HCC) Assessment Randomized Protocol (SHARP) trial demonstrated that sorafenib significantly improved the overall survival in patients with advanced HCC and wellpreserved liver function, and that drug-related adverse events were manageable [6]
According to the subanalysis of phase II sorafenib Asia-Pacific trial, the effectiveness of sorafenib in advanced HCC patients remains unclear as the survival gain in patients with pulmonary metastasis (PM) was only 1.4 months [7]
Summary
Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in Asia, including Korea [1], and ranks third in cancer deaths worldwide [2]. There are reports suggesting that the outcomes of thoracoscopic surgery are not inferior to those of open thoracotomy [13, 28] This disagreement can partly be due to the possibility that finger palpation of the lung has limitations in terms of detecting small nodules; in addition, metastasectomy under a thoracotomy is not always complete [29]. In contrast to the inaccuracy of old-generation CT, the 1-mm-thin section 16-channel multi-detector row CT showed a high detection rate of metastatic pulmonary nodules, especially in patients with non-osteosarcoma It can be a possible substitute for manual palpation [14]. Using propensity score matching (PSM) analysis, we compared the results according to the surgical approach: video-assisted thoracic surgery (VATS) versus the open method
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