Kamimura Kenya, Kobayashi Yuji, Takahashi Yoshifumi, Abe Hiroyuki, Kumaki Daisuke, Yokoo Takeshi, Kamimura Hiroteru, Sakai Norihiro, Sakamaki Akira, Abe Satoshi, Takamura Masaaki, Kawai Hirokazu, Yamagiwa Satoshi, Terai Shuji
a Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University , Asahimachido-ri, Chuo-ku, Niigata , Japan.
Cancer Biol Ther. 2017 Feb;18(2):79-84. doi: 10.1080/15384047.2016.1276134. Epub 2017 Jan 3.
Intrahepatic lesions of hepatocellular carcinoma (HCC) have been controlled by significant advances in treatment using loco-regional therapies, including, surgery, ablative therapy, catheter-based chemotherapy, and embolization. Consequently, the number of patients with extrahepatic metastatic lesions has increased. Their prognosis remains poor with approximately <1 y of survival from the time of diagnosis. A molecularly targeted drug, sorafenib, have been used to treat extrahepatic lesions and shown the prolonged survival time. However, the therapeutic benefit for the brain metastasis remains unclear, since it causes intratumor bleeding leading to the severe brain damage. No guidelines for the brain metastasis of HCC have been developed to date due to the shortage of the experiences and evidences. Therefore, the development of standard therapy for brain metastasis following the early diagnosis is essential by accumulating the information of clinical courses and evidences. For this purpose, we reviewed cases of HCC brain metastasis reported to date and analyzed additional 8 cases from our hospital, reviewing 592 advanced HCC cases to estimate the possible metastatic lesions in the brain. With careful review of cases and literature, we suggest that the cases with lung metastasis with increase tendency of tumor markers within recent 3-6 months have higher risks of brain metastasis. Therefore, they should be carefully followed by imaging modalities. In addition, the loco-regional treatment, including surgical resection and radiation therapy should be performed for better prognosis by preventing re-bleeding from the tumors.
肝细胞癌（HCC）的肝内病变已通过局部区域治疗的重大进展得到控制，这些治疗方法包括手术、消融治疗、导管化疗和栓塞。因此，肝外转移病变患者的数量有所增加。他们的预后仍然很差，从诊断时起存活时间约<1年。一种分子靶向药物索拉非尼已被用于治疗肝外病变，并显示出延长的生存时间。然而，对于脑转移的治疗益处仍不清楚，因为它会导致肿瘤内出血，进而导致严重的脑损伤。由于缺乏经验和证据，迄今为止尚未制定HCC脑转移的指南。因此，通过积累临床病程信息和证据，制定早期诊断后脑转移的标准治疗方法至关重要。为此，我们回顾了迄今为止报道的HCC脑转移病例，并分析了我院另外8例病例，回顾了592例晚期HCC病例，以估计脑内可能的转移病变。通过对病例和文献的仔细回顾，我们建议在最近3 - 6个月内伴有肿瘤标志物升高趋势的肺转移病例发生脑转移的风险更高。因此，应通过影像学检查对其进行密切随访。此外，为了防止肿瘤再次出血，改善预后，应进行包括手术切除和放射治疗在内的局部区域治疗。
