Association of hepatocellular carcinoma in North American patients with extrahepatic primary malignancies

Abstract

Background. The finding of an association between one primary tumor and others is an area of continuing interest from clinical and pathologic viewpoints. The authors studied patients in North American with hepatocellular carcinoma associated with extrahepatic primary malignancies (EHPMs) and compared them with patients who had hepatocellular carcinomas not associated with other neoplasms. The authors know of only four other series that have investigated such cases, none of which was from North America. Methods. The authors retrospectively reviewed 1349 consecutive cases of histologically diagnosed hepatocellular carcinoma (HCC) at the Armed Forces Institute of Pathology over a 14‐year period. Seventy‐four patients (5.5%) had an EHPM, and these were compared with the 1275 patients who did not have another primary malignancy. Statistical comparisons were made using the chisquare statistical or Fisher's exact test, as appropriate, and life‐table survival analyses were performed. Results. Significantly more men (P = 0.02) than women had EHPMs, and their mean age of 69.2 ± 2.1 years was significantly older (P < 0.05) than that of those without EHPMs (59.9 ± 1.0 years). Seventeen (19.8%) EHPMs occurred before HCC, 66 (76.7%) occurred synchronously, and 3 (3.5%) occurred metachronously. The probability of finding an EHPM increased if the nonneoplastic liver was cirrhotic or dysplastic. Mean survival for the HCC with EHPM group did not differ significantly from that for the group without EHPM. Conclusions. Extrahepatic primary malignancies do not significantly influence the survival of patients with HCC. The most common EHPMs associated with HCC are either diseases of old age or those already known to be common among North American populations.

Clinical features and outcome of multiple primary malignancies involving hepatocellular carcinoma: A long-term follow-up study

“…HCC is always associated with a poorer survival and a more aggressive behavior than most other tumors. Several cohort studies noted that the causes of death in HCC patients with EHPM were mostly attributed to HCC itself, not to extrahepatic cancer [3,5]. In light of these data, we stressed the need to prioritize curative treatment for HCC independently of the EHPM, as the presence of an EHPM had little impact on HCC-specific prognosis.…”

“…Although several papers reported MPM concomitant with surgical HCC patients [2-5,23,24], with the small number of patients, the statistical power was limited. Of noted, only two cohort studies investigated the influence of EHPM on survival with more than 20 surgical HCC [2,3]. Furthermore, both of the two papers failed to refer to HCC-specific survival, which lead to decrease the value for clinical practice.…”

“…To the best of our knowledge, only two papers examined the clinicopathological factors of MPM with more than 20 patients [2,3], who had received radical hepatectomy for primary HCC, have been published within the last 20 years. Although small sample-sized studies were performed in Japan [4,5], Taiwan [6], and Western countries [7], none of them were from Mainland China, an area with a high incidence of HCC (> 20 annual cases per 10 5 people) [8].…”

Analysis of Extrahepatic Multiple Primary Malignancies in Patients with Hepatocellular Carcinoma according to Viral Infection Status

“…Genitourinary (mainly prostate) and colorectal tumors are described as the most prevalent sites in Western series [1, 5, 9, 11, 13, 15]. Previous Japanese studies consistently reported gastric cancer as the most frequent EHPM in HCC patients [2–4, 10, 14].…”

“…Di Stasi et al reported that the most common EHPM in their HCC cohort was B-cell lymphoproliferative disorders, with a higher incidence than expected in the reference population, and that 50% of patients with B-cell lymphoproliferative disorders had an HCV infection [9]. However, most other series reported relatively low incidence of B-cell lymphoproliferative disorders in HCC patients [1–5, 7, 8, 10, 11, 15]. …”