Prognostic Factors for Pulmonary Metastasectomy in Hepatocellular Carcinoma

Kuo, Shuenn-Wen; Chang, Yih-Leong; Huang, Pei-Ming; Hsu, Hsao-Hsun; Chen, Jin-Shin; Lee, Jang-Ming; Lee, Po-Huang; Lee, Yung-Chie

PURPOSE: To identify the prognostic factors for pulmonary metastasectomy (PM-ectomy) in hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We conducted a retrospective review of patients with pulmonary metastases (PM) from HCC who had undergone curative PM-ectomy at National Taiwan University Hospital between 1990 and 2004. Univariate (log-rank) and multivariate (Cox’s model) analyses of survival were used to identify the significant prognostic factors. RESULTS: In total, 34 patients were eligible for curative PM-ectomy. The overall survival rates (Kaplan-Meier) after PM-ectomy were 65.2% and 27.5% at 2 and 5 years, respectively. High alpha-fetoprotein level, positive hepatic resection margin, and short disease-free interval (DFI) were unfavorable factors for overall survival from univariate analysis, however, only DFI (P = 0.028) was identified as an independently prognostic factor by multivariate analysis. Bilateral distribution and more PMs were unfavorable factors for PM-free survival from univariate analysis, with only PM number identified as an independent prognostic factor by multivariate analysis (P = 0.017). CONCLUSION: Patients with longer DFIs and fewer PMs can benefit from PM-ectomy in HCC.