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Extrahepatic primary malignancies may not impact HCC-specific survival rate

The presence of extrahepatic primary malignancies does not affect a patient’s hepatocellular carcinoma survival rate and should not preclude such patients from receiving curative therapies, according to recent results.

Researchers evaluated clinicopathological data for 68 patients (61 were men) with multiple extrahepatic primary malignancies (EHPM) involving hepatocellular carcinoma (HCC). The target group included 35 patients who had radical hepatectomy performed, and the researchers also analyzed a 140-patient control group with HCC alone who underwent hepatectomy.

The majority of patients (98.5%) had double cancers, and one patient (1.5%) had triple cancers. Common sites included nasopharynx (16.2%), colorectal (14.7%) and lung (8.8%) cancers. Twenty-two of the patients with EHPM were diagnosed synchronously with HCC, compared with 46 who were diagnosed metachronously.

Follow-up occurred during a median of 7.8 years (range 3.2-16.1 years), during which 36 patients died (52.9%), including 29 (42.6%) due to HCC-related causes, four (5.9%) to EHPM-related causes and three (4.4%) to uncertain causes. Overall survival (OS) rates were 89.3% at 1 year, 63.0% at three years and 51.8% at five years.

Synchronous treatment was found through univariate analysis to be a risk factor for poorer survival rates compared with metachronous (P=.008), as was nonradical EHPM treatment (P<.001). Multivariate analysis indicated that treatment for EHPM was a likely prognostic factor for overall survival (HR=2.758; 95% CI, 1.581-4.811), and that treatment for HCC was a prognostic factor for HCC-specific survival (HR=1.893; 95% CI, 1.297-2.764).

Investigators found a similar degree of postoperative complications between patients with EHPM and those with HCC alone (P=.373), and no benefit in the control group compared with the EHPM group for HCC-specific (P=.607) or recurrence-free survival (P=.131).

“Curative treatment is an independent predictive factor for OS and HCC-specific OS,” the researchers wrote, “and should be taken into account both for synchronous and metachronous patients. … The efficacy of the treatment against HCC and EHPM had great influence on the prognosis. Moreover, EHPM did not confer a poorer HCC-specific survival, and those patients should not be excluded from curative therapies.”