Lin Xiaoning, Zhang Pengfei, Huang Rong, Huang Yanlin, Sun Jin, Zheng Huili, Tian Xinhua, Wang Xiaomin
Department of Neurosurgery, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen University Affiliated Zhongshan Hospital, Xiamen, China.
Institute of Molecular Immunology, School of Biotechnology, Southern Medical University, Guangzhou, China.
Ann Palliat Med. 2020 Sep;9(5):2654-2667. doi: 10.21037/apm-20-1012. Epub 2020 Aug 31.
This study aimed to identify the incidence, risk factors, and survival outcome associated with brain metastases (BM) in hepatocellular carcinoma (HCC) patients using a large-scale population-based cancer registry database.
Between 2010 and 2016, patients with BM from HCC were included using the Surveillance, Epidemiology, and End Results (SEER) program. The risk and prognostic factors for BM were recognized by multivariate logistic and Cox regression model analysis. The overall survival (OS) and cancer-specific survival (CSS) of HCC patients with BM were assessed using Kaplan-Meier curves with log-rank tests.
A total of 141 (0.33%) HCC patients detected with BM were included for analysis. Younger age, tumor pathological undifferentiation, no surgery, radiation therapy, no chemotherapy, synchronous bone, or lung metastases were positively associated with BM in the HCC cohort. The median OS and CSS of the BM patients were 3 months, while the corresponding survival time in HCC patients without BM was 13 and 23 months. Black race, tumor pathological undifferentiation, absence of chemotherapy, and concomitant lung metastases were independently associated with the worse survival.
Although the overall prognosis of patients with BM from HCC was extremely poor, a list of homogeneous and heterogeneous risk factors were found to be significantly associated with the occurrence and prognosis of BM in HCC patients. These relevant factors may provide more valuable references for individualized treatment in clinical practice.
本研究旨在利用大规模人群癌症登记数据库，确定肝细胞癌（HCC）患者脑转移（BM）的发生率、危险因素和生存结局。
2010年至2016年期间，使用监测、流行病学和最终结果（SEER）计划纳入来自HCC的BM患者。通过多因素逻辑回归和Cox回归模型分析确定BM的风险和预后因素。使用Kaplan-Meier曲线和对数秩检验评估HCC伴BM患者的总生存期（OS）和癌症特异性生存期（CSS）。
共纳入141例（0.33%）检测到BM的HCC患者进行分析。在HCC队列中，年龄较小、肿瘤病理未分化、未手术、未放疗、未化疗、同时发生骨或肺转移与BM呈正相关。BM患者的中位OS和CSS为3个月，而无BM的HCC患者相应的生存时间分别为13个月和23个月。黑人种族、肿瘤病理未分化、未进行化疗以及同时发生肺转移与较差的生存独立相关。
尽管HCC伴BM患者的总体预后极差，但发现一系列同质和异质危险因素与HCC患者BM的发生和预后显著相关。这些相关因素可为临床实践中的个体化治疗提供更有价值的参考。
