Hepatocellular Carcinoma Pulmonary Metastases Research Articles

Prognostic factors in patients with first diagnosis of hepatocellular carcinoma presenting with pulmonary metastasis and construction of a clinical prediction model.

In some areas where routine screening for hepatocellular carcinoma is not available, 30% of HCC patients present with extra-hepatic metastases at the first visit. The most common metastatic organ among them is the lung. The factors influencing the prognosis of this particular subgroup are questions that deserve to be explored. We screened the patients using the SEER database. After exclusion, 989 patients with first diagnosis of hepatocellular carcinoma with lung metastasis were included in this study. Based on Cox regression, the random forest and stepwise methods were applied to screen out risk factors that independently affect the overall survival or disease-specific survival of HCCPM patients and construct prognostic models, respectively. The data were set as training and validation sets, and the reliability and accuracy of the models were verified in different data sets using time-dependent ROC curves with decision curves. We found that the clinical factors affecting the overall survival of HCCPM patients were age grouping, chemotherapy, AJCC T-stage, pathologic grading, and surgery. The clinical factors affecting disease-specific survival in patients with hepatocellular carcinoma pulmonary metastases were age grouping, marital status, AJCC T-stage, pathological grading, and surgery. For the OS model for the training cohort, the 6-month AUC = 0.695, 12-month AUC = 0.692, and 18-month AUC = 0.72. While the DSS model for the training cohort resulted in a 6-month AUC = 0.671, 12-month AUC = 0.671, and 18-month AUC = 0.635. In this study, we developed and validated a model of prognostic risk factors for patients with lung metastases from hepatocellular carcinoma. Our prognostic model can prospectively predict the prognostic status of patients and improve clinical efficiency.

Efficacy and Safety of Anti-Programmed Cell Death Protein-1 Immunotherapy for Advanced Hepatocellular Carcinoma With Pulmonary Metastases: A Single-Center, Retrospective Study

Background:Anti-programmed cell death protein-1 immunotherapy has been approved as a new treatment option for advanced hepatocellular carcinoma (HCC) based on the promising results of several studies.Methods:This retrospective study included 71 patients with advanced HCC treated with anti-programmed cell death protein-1 immunotherapy between June 1, 2017 and September 30, 2020 at the First Affiliated Hospital of Anhui Medical University. Responses to pulmonary metastases were evaluated.Results:The median follow-up duration was 7.73 months (95% confidence interval (CI), 4.48-10.98). Of 71 patients, the overall response rate (ORR) and disease control rate (DCR) were 32% (23/71) and 73% (52/71), respectively. The median progression-free survival (PFS) and overall survival (OS) were 4.90 (95% CI, 2.71-7.09) and 20.23 (95% CI, 6.87-33.59) months, respectively. Forty-two patients had HCC pulmonary metastases, whereas 29 did not have pulmonary metastasis. No significant differences were observed in the ORR (38% [16/42] vs. 24% [7/29], P = 0.22) and DCR (74% [31/42] vs. 72% [21/29], P = 0.90) between groups. In patients with pulmonary metastases, the median disease control duration of pulmonary lesions was significantly longer than extrapulmonary lesions (Not Reached vs. 12.37 months, P = 0.048). Pulmonary metastases were not associated with an increased incidence of adverse events (67% vs. 62%, P = 0.69).Conclusions:Anti-programmed cell death protein-1 immunotherapy showed promising efficacy and safety in patients with advanced HCC, with good responses observed in pulmonary metastases. The mechanism underlying the differences in responses between pulmonary and extrapulmonary metastases requires further investigation.

Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases

Purpose: This study aimed to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for unresectable hepatocellular carcinoma pulmonary metastases (HCCPM) and to identify the prognostic factors for survival.Materials and methods: We reviewed the medical records of 320 patients with HCCPM treated between January 2005 and January 2012. Among them, 29 patients with 68 lesions of unresectable HCCPM underwent 56 RFA sessions. Safety, local efficacy, survival and prognostic factors were evaluated. Survival was analysed using the Kaplan-Meier method. Univariate analyses were evaluated by the log-rank test.Results: Pneumothorax requiring chest tube placement occurred in five (8.9%, 5/56) RFA sessions. During the median follow-up period of 23 months (range 6–70), 18 patients (62.1%, 18/29) died of tumour progression and 11 (37.9%, 11/29) were alive. The 1-, 2- and 3-year overall survival rates were 73.4%, 41.1% and 30%, respectively. The median progression-free survival was 18 months (95% confidence interval (CI) 9.8–26.2) and the median overall survival time was 21 months (95%CI, 9.7–32.3). The maximum tumour diameter ≤3 cm (p = 0.002), the number of pulmonary metastases ≤3 (p = 0.014), serum AFP level ≤400 ng/mL (p = 0.003), and the controlled status of intrahepatic tumour after lung RFA (p = 0.001) were favourable prognostic factors for overall survival.Conclusions: Our study indicates that percutaneous CT-guided RFA, as an alternative treatment procedure to pulmonary metastasectomy, can be a safe and effective therapeutic option for unresectable HCCPM.