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  • Title: Therapeutic significance and indications of pulmonary metastasectomy for hepatocellular carcinoma following liver resection.
    Author: Hu Z, Li W, Huang P, Zhou Z, Xu J, Xu K, Wang J, Zhang H.
    Journal: Int J Surg; 2017 Dec; 48():23-31. PubMed ID: 28987561.
    Abstract:
    BACKGROUND: To explore the therapeutic significance and indications of pulmonary metastasectomy (PMT) in hepatocellular carcinoma (HCC) patients with pulmonary metastasis (PM) following liver resection (LR). PATIENTS AND METHODS: PM-HCC patients who underwent LR were retrospectively enrolled, and survival outcomes and prognostic factors were analyzed. Patients were divided into PMT and non-PMT group, and propensity score matching (PSM) analysis was used for survival comparison. Prognostic analysis and survival comparisons were performed specifically in PMT patients. RESULTS: Ninety-seven patients were enrolled, among which twenty-six underwent PMT while seventy-one did not. Survival outcome was superior in PMT group compared to non-PMT group (33.5 vs. 10.5 months) (p = 0.003), while no statistical difference was found after PSM analysis (33.5 vs. 11.2 months) (p = 0.138). Synchronous PM-HCC, serum alpha fetal protein≥400 ng/ml at PM diagnosis, no intrahepatic treatments (LR, ablation or transarterial chemoembolization) after LR, intrahepatic recurrence or metastasis at repeated PM diagnosis were inferior independent prognostic factors in PMT patients (p < 0.05). Superior survival outcomes were seen in candidate PMT patients when corresponding indications were satisfied (p = 0.014, p = 0.005). CONCLUSION: PMT might provide potential survival benefits in well selected PM-HCC patients who underwent LR. Well designed, multi-institutional studies with larger patient number were still to be required.
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