Prognostic Analysis of Surgical Resection for Pulmonary Metastasis from Hepatocellular Carcinoma
BACKGROUND This study aimed to present our experience with pulmonary metastasectomy in the treatment of hepatocellular carcinoma and to evaluate the prognostic factors. METHODS The clinicopathologic data of 17 patients including presence of viral hepatitis, the serum alpha-fetoprotein (AFP) level, the number of metastases, and laterality were analyzed. The overall survival rates and the prognostic factors were estimated using the Kaplan-Meier method and Cox proportional hazards model for multivariate analysis. RESULTS The median follow-up periods after pulmonary resection and initial hepatic resection were 28.9 and 46.2 months, respectively. The actuarial overall 1-, 3-, and 5-year survival rates after pulmonary metastasectomy were 64.7 +/- 11.6%, 29.4 +/- 11.1%, and 11.8 +/- 7.8%, respectively. Using multivariate analysis, disease-free interval (DFI) of more than 24 months (hazard ratio = 2.36, 95% confidence interval = 1.33-25.33, p = 0.020) and AFP levels after pulmonary resection (hazard ratio = 51.3 95% confidence interval = 3.68-716.66, p = 0.003) were found to be independent prognostic factors. CONCLUSIONS Although only a small number of patients were enrolled in this study, a disease-free interval more than 24 months and the serum AFP level after pulmonary metastasectomy might be important prognostic factors.