Long-Term Survival and Prognostic Factors after Pulmonary Metastasectomy in Hepatocellular Carcinoma

Background. The lung is the most common site of extrahepatic recurrence from hepatocellular carcinoma (HCC), but the standard treatment for pulmonary metastasis (PM) from HCC has not been established. We analyzed patients who underwent pulmonary resection for HCC metastases to evaluate long-term survival and prognostic factors. Methods. We retrospectively reviewed patients who underwent pulmonary metastasectomy due to HCC at Samsung Medical Center between 1998 and 2008. Clinical/pathological features and prognoses were investigated. Results. Fifty-two pulmonary metastasectomies were performed in 45 patients (38 men) with PM. Average patient age was 50.9 +/- 11.0 years. Video-assisted thoracic surgery was used in 24 patients. Lobectomy was performed in eight patients and wedge resection in the others. Median survival after pulmonary metastasectomies was 40.7 months, and the 5-year overall survival rate was 37%. First recurrence in lung (P = 0.03), a long disease-free interval (P = 0.02), and solitary PM (P = 0.03) were found to be favorably associated with overall survival by univariate analysis. However, multivariate analysis failed to identify any independent prognostic factor associated with survival. Nevertheless, first recurrence in lung was found to be a favorable factor of PM-free survival by univariate (P = 0.01) and multivariate analyses (P = 0.022, hazard ratio = 0.382). Conclusions. Pulmonary metastasectomies in selected patients with HCC was found to have a relatively good survival rate. Although no independent prognostic factor was found to be associated with overall survival, pulmonary metastasectomy may be effective in patients with a single PM and a long disease-free interval.