Clinical outcome after pulmonary metastasectomy from primary hepatocellular carcinoma: analysis of prognostic factors.

AIM

To review the surgical outcomes in terms of the surgical indications and relevant prognostic factors.

METHODS

Sixteen patients underwent therapeutic lung surgery between March 1999 and May 2006. The observation period was terminated on May 31, 2007. The surgical outcomes and the clinicopathological factors were compared.

RESULTS

There was no mortality or major morbidity encountered in this study. The mean follow-up period after metastasectomy was 26.7 +/- 28.2 (range: 1-99 mo), and the median survival time was 20 mo. The 1- and 5-year survival rates were 56% and 26%, respectively. At the end of the follow-up, 1 patient died from hepatic failure without recurrence, 6 died from hepatic failure with a recurrent hepatocellular carcinoma (HCC), and 4 died from recurrent HCC with cachexia. Among several clinical factors, Kaplan-Meier analysis revealed that liver transplantation as a treatment for the primary lesion, grade of cell differentiation, and negative evidence HBV infection were independent predictive factors. On Cox's proportional hazard model, there were no significant factors affecting survival after pulmonary metastasectomy in patients with HCC.

CONCLUSION

A metastasectomy should be performed before other treatments in selected patients. Although not significant, patients with liver transplantation of a primary HCC survived longer. Liver transplantation might be the most beneficial modality that can offer patients better survival. A multi-institutional and collaborative study would be needed for identifying clinical prognostic factors predicting survival in patients with HCC and lung metastasis.