Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
The Catholic Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Int J Clin Oncol. 2019 Jun;24(6):666-676. doi: 10.1007/s10147-019-01407-z. Epub 2019 Feb 20.
Brain metastasis is a rare event in patients with hepatocellular carcinoma (HCC). This retrospective study aimed to identify the prognostic factors and determine the outcomes of patients with brain metastases from HCC.
About 86 patients with brain metastases (0.6%) from HCC were identified from two institutions; of them, 32 underwent tumor-removing surgery or stereotactic radiosurgery (SRS) with or without adjuvant whole brain radiotherapy (WBRT) (group 1), 30 had WBRT alone (group 2), and 24 received conservative treatment (group 3). Estimates for overall survival (OS) after brain metastases were determined, and clinical prognostic factors were identified.
The median OS after development of brain metastases was 50 days. About 75 (87.2%) patients had lung metastases at the time of brain metastasis diagnosis. Group 1 showed better OS, followed by group 2 and group 3, sequentially (p < 0.001). Univariate analyses showed that treatment with curative intent (surgery or SRS), Child-Pugh class A, alpha-fetoprotein level < 400 ng/ml, and recursive partitioning analysis classification I or II were associated with improved survival (p < 0.001, 0.002, 0.029, and 0.012, respectively). Multivariate analysis showed that treatment with curative intent and Child-Pugh class A was associated with improved OS (p < 0.001 and 0.009, respectively).
Although the overall prognosis of patients with brain metastases from HCC is extremely poor, patients actively treated with surgery or radiosurgery have prolonged survival, suggesting that interventions to control intracranial disease are important in these patients.
脑转移是肝细胞癌（HCC）患者中罕见的事件。本回顾性研究旨在确定脑转移患者的预后因素，并确定其结局。
从两个机构中确定了 86 例 HCC 脑转移患者（0.6%）；其中 32 例患者接受了肿瘤切除术或立体定向放射外科手术（SRS），并联合或不联合辅助全脑放疗（WBRT）（1 组），30 例患者仅接受 WBRT（2 组），24 例患者接受保守治疗（3 组）。确定脑转移后的总生存（OS）估计值，并确定临床预后因素。
脑转移后中位 OS 为 50 天。约 75（87.2%）例患者在脑转移诊断时已有肺转移。1 组 OS 较好，2 组和 3 组依次较差（p<0.001）。单因素分析显示，根治性治疗（手术或 SRS）、Child-Pugh 分级 A、甲胎蛋白水平<400ng/ml 和递归分区分析分类 I 或 II 与生存改善相关（p<0.001、0.002、0.029 和 0.012）。多因素分析显示，根治性治疗和 Child-Pugh 分级 A 与 OS 改善相关（p<0.001 和 0.009）。
尽管 HCC 脑转移患者的总体预后极差，但积极接受手术或放射外科治疗的患者生存时间延长，这表明控制颅内疾病的干预措施对这些患者很重要。
