P-0023 - Metastatic hepatocellular carcinoma; clinicopathological characterization and survival analysis
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Hepatobiliary Cancers
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
O. Abdel-Rahman1, S. Abdel Wahab2, M. Shaker2, M. Elbassiouny2, M. Ellithy2
With the widespread implementation of nationwide HCC screening strategies and successful implementation of proper locoregional therapies for early lesions, later systemic relapse of HCC is more frequently encountered. Thus we have conducted a retrospective analysis of our HCC database to help determine the characters and outcome data of this subset of HCC patients.
Unresectable HCC patients referred for systemic therapy to clinical oncology department, Ain Shams University hospitals in the period from 2010-2012 were reviewed. Eligible patients were those who had radiological or histopathological confirmation of the diagnosis. We compared the difference in clinicopathological parameters between cases that have distant metastatic disease (including metastatic lymphadenopathy) and cases that have localized disease. We investigated the impact of disease extent on overall survival (OS) in a Cox regression model adjusted for age, BCLC stage, performance status and treatment.
52 patients were included in the analysis fulfilling the inclusion criteria. 23 patients were confirmed have metastatic HCC whilst the rest of the cases have localized disease. Median age for non metastatic HCC was younger than metastatic HCC (54 vs. 59), patients with metastatic HCC were more likely to have ECOG performance score 2 (p = 0.001) while they are less likely to have macroscopic vascular invasion. Sites of extra hepatic spread included bone metastasis (9 patients), lymph nodes (6 patients) and lung in 4 patients. All patients were BCLC C and were offered systemic treatment; additionally 9 patients received palliative bone radiotherapy (in case of bone metastasis) and 2 patients were offered TACE as an additional modality to systemic therapy. 2 patients have developed distant metastasis after previous liver transplantation and one case after previous liver resection. The median OS for the whole group was 6.25 months, for the metastatic HCC group it was 7.01 months while for the localized HCC group it was 6.25 months and based on univariate analysis, extra hepatic spread was not associated with shorter PFS or OS.
An aggressive therapeutic approach could lead to a durable remission of metastatic HCC in a reasonable number of patients with good performance status and adequate liver function. However, proper multidisciplinary discussion is mandatory before adopting such an approach in the individual patient.