Falkson Samuel R, Bhambhvani Hriday P, Hayden Gephart Melanie
Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
World Neurosurg. 2020 Aug;140:e27-e32. doi: 10.1016/j.wneu.2020.03.189. Epub 2020 Apr 11.
Brain metastases (BMs) from hepatocellular carcinoma (HCC) are rare, with a paucity of reported cases. In the present retrospective cohort report, we assessed the proportion of BMs arising from HCC and characterized the related details, including patient demographics, clinical characteristics, treatment modalities, and survival outcomes.
We retrospectively identified and reviewed the medical records of 14 patients with BMs from HCC seen at our institution from 2008 to 2018.
Among all patients with BMs, the proportion originating from primary liver cancer was 0.39%. In every case (n = 14), the liver cancer was HCC. The median age at the BM diagnosis was 64 years (range, 37-82 years). The median alpha-fetoprotein level at the diagnosis of BM was 540 ng/mL (range, 3-10,000 ng/mL). The median interval from the HCC diagnosis to the development of BMs was 31.1 months (range, 3.17-107 months). Of the 14 patients, 8 (57%) had had metastases to the brain parenchyma and 6 had had skull or dural metastases. For patients with brain parenchymal metastases, the median number of metastases was 1 (range, 1-5). Of the 14 patients, 13 have died, with a median overall survival after the BM diagnosis of 2.83 months (range, 0.430-24.0 months). At the latest follow-up examination, the survival for the 14th patient was 142 months after the BM diagnosis. Resection of BMs with radiosurgery was associated with increased survival compared with radiosurgery alone (10.9 months vs. 2.8 months; P = 0.04).
HCC BMs are rare and constitute a small fraction of the total incidence of BMs. The prognostic data we have provided can aid medical providers in caring for patients with HCC BMs.
肝细胞癌（HCC）脑转移（BMs）较为罕见，报道的病例较少。在本回顾性队列报告中，我们评估了HCC发生BMs的比例，并对相关细节进行了描述，包括患者人口统计学特征、临床特征、治疗方式和生存结果。
我们回顾性地识别并审查了2008年至2018年在本机构就诊的14例HCC脑转移患者的病历。
在所有脑转移患者中，原发于肝癌的比例为0.39%。每例（n = 14）患者的肝癌均为HCC。脑转移诊断时的中位年龄为64岁（范围37 - 82岁）。脑转移诊断时甲胎蛋白的中位水平为540 ng/mL（范围3 - 10,000 ng/mL）。从HCC诊断到发生脑转移的中位间隔时间为31.1个月（范围3.17 - 107个月）。14例患者中，8例（57%）发生脑实质转移，6例发生颅骨或硬脑膜转移。对于脑实质转移患者，转移灶的中位数量为1个（范围1 - 5个）。14例患者中，13例死亡，脑转移诊断后的中位总生存期为2.83个月（范围0.430 - 24.0个月）。在最近一次随访检查时，第14例患者在脑转移诊断后的生存期为142个月。与单纯放射外科手术相比，采用放射外科手术联合脑转移瘤切除术可提高生存率（10.9个月对2.8个月；P = 0.04）。
HCC脑转移罕见，在脑转移总发病率中占比很小。我们提供的预后数据有助于医疗人员对HCC脑转移患者的护理。
