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Surgical outcomes for pulmonary metastases from hepatocellular carcinoma

^a Division of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
^b Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
^c Department of Chest Surgery, Tochigi Prefectural Cancer Center, Tochigi, Japan
^d Department of General Thoracic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
^e Department of Cardiothoracic Surgery, Dokkyo Medical University, Tochigi, Japan
^f Department of Chest Surgery, Cancer Institute Hospital, Tokyo, Japan
^g Department of Thoracic Surgery, Chiba University, Chiba, Japan

Received 27 September 2007; received in revised form 24 March 2008; accepted 31 March 2008.

^_* Corresponding author. Address: Division of General Thoracic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582 Japan. Tel.: +81 3 5363 3806; fax: +81 3 5363 3499. (Email: kawamura{at}sc.itc.keio.ac.jp).

Background: Although favourable prognosis following aggressive treatment of extrahepatic metastases from hepatocellular carcinoma (HCC) has been reported, surgical outcomes for pulmonary metastases are unclear. Methods and materials: Sixty-one patients (2.6%) of 2297 registered with the Metastatic Lung Tumor Study Group of Japan between 1990 and 2006, who underwent surgery for pulmonary metastases from HCC, were retrospectively reviewed from the registry. Results: The overall 5-year survival rate was 32.2%. The prognosis was significantly better for 2 lesions than for 3 lesions (p = 0.046), for 3 lesions than for 4 lesions (p = 0.0070), and for 4 lesions than for 5 lesions (p = 0.029). No other factors that influence outcomes were identified. A stepwise regression analysis showed three or less pulmonary metastases to be an independent factor for better prognosis (p = 0.048). Conclusion: With careful patient selection, comparatively good outcomes can be expected following surgical resection of pulmonary HCC metastases. Among them, patients with multiple metastases, if number of metastases is small such as four or less, can be expected to survive long after surgery.

Key Words: Hepatocellular carcinoma • Pulmonary metastasis • Extrahepatic metastasis • Surgery • Metastasectomy