Choi Hye Jin, Cho Byung Chul, Sohn Joo Hyuk, Shin Sang Jun, Kim Se Hyun, Kim Joo Hang, Yoo Nae Choon
Division of Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seodaemun-gu shinchon-dong 134, Seoul, Korea.
J Neurooncol. 2009 Feb;91(3):307-13. doi: 10.1007/s11060-008-9713-3. Epub 2008 Oct 23.
Brain metastases from hepatocellular carcinoma are extremely rare. The objectives of the current study were to assess the natural history, outcome, and possible prognostic factors in patients with brain metastases from hepatocellular carcinoma. Between 1995 and 2006, 6,919 patients with hepatocellular carcinoma were treated at Yonsei University Health System. Of those, 62 (0.9%) had a diagnosis of brain metastasis. We carried out a retrospective review of these 62 patients and performed a statistical analysis. The median age at the time patients were diagnosed with brain metastasis was 54 years. Forty-seven patients (76%) were male, and 53 patients had hepatitis B. Median time from diagnosis of hepatocellular carcinoma to brain metastasis was 18.2 months, and 5 patients had brain involvement as their initial presentation. Intracranial hemorrhage was frequently associated (54.8%) with brain metastasis. The most common presenting symptoms were motor weakness, mental change, and headache. Metastases were treated with whole-brain radiation therapy (WBRT) alone in 17 patients and gamma knife surgery alone in 10 patients. Six patients underwent surgical resection and 5 patients were treated with surgical resection followed by WBRT. Twenty-four patients (39%) received steroids only. Median survival after diagnosis of brain metastasis was 6.8 weeks (95% confidence interval: 3.8-9.8 weeks). Univariate analysis showed that treatment modality, number of brain lesions, alpha-fetoprotein, ECOG performance score, recursive partitioning analysis (RPA) class, and Child-Pugh classification had a statistically significant impact on survival. In multivariate analysis, treatment modality, number of brain lesions, and Child-Pugh classification were statistically significant prognostic factors for survival. The overall prognosis of patients with brain metastases from hepatocellular carcinoma is extremely poor. Nevertheless, some subsets of patients manifested the most favorable survival criteria (single brain metastasis and good liver function); thus, for at least these patients, treatment may result in an improved survival time.
肝细胞癌脑转移极为罕见。本研究的目的是评估肝细胞癌脑转移患者的自然病程、结局及可能的预后因素。1995年至2006年间，延世大学健康系统治疗了6919例肝细胞癌患者。其中，62例（0.9%）被诊断为脑转移。我们对这62例患者进行了回顾性分析并进行了统计分析。患者被诊断为脑转移时的中位年龄为54岁。47例（76%）为男性，53例有乙型肝炎。从肝细胞癌诊断到脑转移的中位时间为18.2个月，5例以脑受累为首发表现。颅内出血常与脑转移相关（54.8%）。最常见的首发症状是运动无力、精神改变和头痛。17例患者仅接受全脑放疗（WBRT），10例患者仅接受伽玛刀手术。6例患者接受了手术切除，5例患者接受了手术切除后再进行WBRT。24例患者（39%）仅接受了类固醇治疗。脑转移诊断后的中位生存期为6.8周（95%置信区间：3.8 - 9.8周）。单因素分析显示，治疗方式、脑转移瘤数量、甲胎蛋白、东部肿瘤协作组（ECOG）体能状态评分、递归分区分析（RPA）分级和Child-Pugh分级对生存有统计学显著影响。多因素分析显示，治疗方式、脑转移瘤数量和Child-Pugh分级是生存的统计学显著预后因素。肝细胞癌脑转移患者的总体预后极差。然而，部分患者亚组表现出最有利的生存标准（单个脑转移瘤和良好肝功能）；因此，至少对于这些患者，治疗可能会延长生存时间。
