Introduction: Hepatocellular carcinoma (HCC) frequently metastasizes to the spine. The impact of medical and/or surgical intervention on overall survival has been examined in a limited number of clinical studies, and herein we systematically review these data.

Methods: We performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles that reported survival, clinical outcomes and/or prognostic factors of HCC patients with spinal metastases. The methodological quality of each review was assessed using the PRISMA tool.

Results: : 26 studies (152 patients) met the inclusion criteria and were treated with either surgery, radiotherapy, chemotherapy and/or observation, respectively. There were 3 retrospective cohort studies, 17 case reports, 5 case series, and 1 longitudinal observational study. Of the patients with known overall survival after diagnosis of spinal metastasis, survival at 3 months, 6 months, 1 year, 2 years, and 5 years was 95.2%, 83.0%, 28.6%, 2.0%, and 1.4% respectively. The median survival after diagnosis of the metastasis was 0.7 months in the patients who received no treatment, 7 months in the patients treated with surgical intervention alone, 6 months for patients who received chemotherapy and/or radiation and 13.5 months in the patients treated with a combination of surgery and medical management. All other clinical or prognostic parameters were of low or insufficient strength.

Conclusions: Patients diagnosed with HCC spinal metastasis have a 10.6 month overall survival. Further analysis of patients in prospective controlled trials will be essential to the development of treatment algorithms for these patients in the future.

Patient Care: This study provides a stepping stone for assessing the benefits and risks of surgical interventions in HCC patients with spinal metastasis and also to determine the appropriate prognostic factors that can predict which patients will benefit maximally from surgical intervention

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the literature on hepatocellular carcinoma metastasis to the spine

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