Control of intracranial disease is associated with improved survival in patients with brain metastasis from hepatocellular carcinoma

Impact of homogeneous and heterogeneous risk factors on the incidence and prognosis of brain metastases in patients with hepatocellular carcinoma

“…Up to now, there are no guidelines on diagnosis and therapeutic strategy for HCCBM, owing to the rarity and poor prognosis of these patients. However, compared to metastatic tumor control, it is widely acknowledged that better-control of primary HCC lesion contributes to longer survival time because patients' survival mainly relies on the condition of the liver function determined by intrahepatic tumor burden (7,31,32). Our study showed that surgery for HCC could decrease the risk of BM, but have no significant influence on patients' prognosis.…”

“…However, it was also found that younger patients had a higher incidence of lung metastases in previous reports, which might be due to the potentially longer survival time and then more chance to develop metastases. Previous studies also indicated that HCCBM patients had a high proportion of synchronous extra-cranial metastases, with lung (32.6-94.8%) and bone (14.7-40.7%) ranking the first two common sites (7)(8)(9)(10)18,22,26). An investigation worked by Seinfeld et al found that some BM could be secondary to lung deposits in HCC patients (11).…”

“…In comparison with other primary tumor sources, like lung cancer (23) and breast cancer (24), or other extrahepatic metastases places, BM from HCC is relatively uncommon, which may be due to the low affinity of HCC for the central nervous system (CNS) and the rapid disease course and short survival time of patients with HCC, which decreases the probability of BM (18,25). Nam reported that 0.6% of 13,581 patients with HCC treated in Seoul St. Mary's Hospital and Incheon St. Mary's Hospital were diagnosed with BM between 1995 and 2017 (7).…”

“…Although the rate of extrahepatic metastases can reach to 18.4% in newly diagnosed HCC patients, brain metastases (BM) are relatively rare, and it could dramatically worsen patients' prognosis (5). According to previously statistical data, the incidence of BM occurs in about 0.2-2.2% of HCC patients with a median overall survival (OS) of 1-6 months (6)(7)(8)(9)(10)(11). Results from a published population study showed that the 1-year OS and cancer-specific survival (CSS) was 5.9% and 6.3% in patients diagnosed with HCCBM (5).…”

Treatment strategies for hepatocellular carcinoma with extrahepatic metastasis

“…For bone metastasis, the pain relief rate ranging from 77% to 96.7% has been reported, although treatment-related lymphopenia associated with a poor survival in patients receiving radiotherapy for bone metastasis from HCC needed to be attended[ 100 - 103 ]. For brain metastasis which is rare with an extremely poor prognosis (median OS around 3 mo), palliative treatments using whole-brain radiotherapy stereotactic radiosurgery might improve survival by controlling intracranial tumor and preventing intracranial hemorrhage[ 104 - 107 ].…”