In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Systematic Review of Hepatocellular Carcinoma Spinal Metastasis.

    Final Number:

    C. Rory Goodwin MD PhD; Vijay Yanamadala MD; Alejandro Ruis-Valls; Nancy A Abu-Bonsrah BS; Ganesh Shankar MD, PhD; Eric W. Sankey BS, MD; Ilya Laufer MD; Mark H. Bilsky MD; Charles Fisher MD; John H. Shin MD; Daniel M. Sciubba BS, MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    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

    References: 1. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. Aug 2010;19(8):1893-1907. 2. Park KW, Park JW, Choi JI, et al. Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area. Journal of gastroenterology and hepatology. Mar 2008;23(3):467-473. 3. Gomaa AI, Khan SA, Toledano MB, Waked I, Taylor-Robinson SD. Hepatocellular carcinoma: epidemiology, risk factors and pathogenesis. World journal of gastroenterology : WJG. Jul 21 2008;14(27):4300-4308. 4. Tabrizian P, Roayaie S, Schwartz ME. Current management of hepatocellular carcinoma. World journal of gastroenterology : WJG. Aug 14 2014;20(30):10223-10237. 5. Chang UK, Kim MS, Han CJ, Lee DH. Clinical result of stereotactic radiosurgery for spinal metastasis from hepatocellular carcinoma: comparison with conventional radiation therapy. J Neurooncol. Aug 2014;119(1):141-148. 6. Chang UK, Youn SM, Park SQ, Rhee CH. Clinical results of cyberknife(r) radiosurgery for spinal metastases. J Korean Neurosurg Soc. Dec 2009;46(6):538-544. 7. Du J, Qian X, Liu B. Long-term progression-free survival in a case of hepatocellular carcinoma with vertebral metastasis treated with a reduced dose of sorafenib: Case report and review of the literature. Oncol Lett. Jan 2013;5(1):381-385. 8. Fukutomi M, Yokota M, Chuman H, et al. Increased incidence of bone metastases in hepatocellular carcinoma. Eur J Gastroenterol Hepatol. Sep 2001;13(9):1083-1088. 9. Kim CH, Chung CK, Jahng TA, Kim HJ. Surgical outcome of spinal hepatocellular carcinoma metastases. Neurosurgery. Apr 2011;68(4):888-896. 10. Kim SU, Kim do Y, Park JY, et al. Hepatocellular carcinoma presenting with bone metastasis: clinical characteristics and prognostic factors. J Cancer Res Clin Oncol. Dec 2008;134(12):1377-1384. 11. Lin S, Hoffmann K, Schemmer P. Treatment of hepatocellular carcinoma: a systematic review. Liver Cancer. Nov 2012;1(3-4):144-158. 12. Santini D, Pantano F, Riccardi F, et al. Natural history of malignant bone disease in hepatocellular carcinoma: final results of a multicenter bone metastasis survey. PLoS One. 2014;9(8):e105268. 13. Lin CH, Chang WN, Lu CH, et al. Clinical characteristics of spinal involvement in hepatocellular carcinoma. Acta Neurol Taiwan. Dec 2009;18(4):255-261. 14. Abbas A, Medvedev S, Shores N, et al. Epidemiology of metastatic hepatocellular carcinoma, a nationwide perspective. Digestive diseases and sciences. Nov 2014;59(11):2813-2820. 15. Liaw CC, Ng KT, Chen TJ, Liaw YF. Hepatocellular carcinoma presenting as bone metastasis. Cancer. Oct 15 1989;64(8):1753-1757. 16. Kuhlman JE, Fishman EK, Leichner PK, Magid D, Order SE, Siegelman SS. Skeletal metastases from hepatoma: frequency, distribution, and radiographic features. Radiology. Jul 1986;160(1):175-178. 17. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. Jul 2009;6(7):e1000100. 18. West S, King V, Carey TS, et al. Systems to rate the strength of scientific evidence. Evidence report/technology assessment. Mar 2002(47):1-11. 19. Goodwin CR, Sankey EW, Liu A, et al. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases. Journal of neurosurgery. Spine. Nov 6 2015:1-13. 20. Abbas SH, Khan MZ, Ijaz M, Hussain SJ. Metastatic hepatocellular carcinoma to the pelvis and vertebrae in a patient with chronic hepatitis 'C' with unknown primary. BMJ Case Rep. 2015;2015. 21. Asahara T, Dohi K, Hino H, et al. A case of hepatocellular carcinoma with bone metastasis responding to radiotherapy after successful hepatectomy of primary lesion. Hiroshima J Med Sci. Mar 1999;48(1):35-39. 22. Chen H, Xiao J, Yang X, Zhang F, Yuan W. Preoperative scoring systems and prognostic factors for patients with spinal metastases from hepatocellular carcinoma. Spine (Phila Pa 1976). Nov 1 2010;35(23):E1339-1346. 23. Doval DC, Bhatia K, Vaid AK, et al. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma. World J Gastroenterol. Aug 28 2006;12(32):5247-5252. 24. Gahr S, Wissniowski T, Zopf S, Strobel D, Pustowka A, Ocker M. Combination of the deacetylase inhibitor panobinostat and the mul-ti-kinase inhibitor sorafenib for the treatment of metastatic hepatocellu-lar carcinoma - Review of the underlying molecular mechanisms and first case report. Journal of Cancer. 2012;3(1):158-165. 25. Garcia VA, Castillo R. Asymptomatic advanced hepatocellular carcinoma presenting with spinal cord compression. Dig Dis Sci. Feb 2005;50(2):308-311. 26. Ha KY, Kim YH, Yoo TW. Intraoperative radiofrequency ablation for metastatic spine disease: report of 4 cases and review. Eur J Orthop Surg Traumatol. Nov 2013;23 Suppl 2:S129-134. 27. Kantharia B, Nizam R, Friedman H, Vardan S. Case report: spinal cord compression due to metastatic hepatocellular carcinoma. Am J Med Sci. Oct 1993;306(4):233-235. 28. Katonis P, Pasku D, Alpantaki K, Bano A, Tzanakakis G, Karantanas A. Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty. World J Surg Oncol. 2009;7:90. 29. Kilickap S, Kars A, Hamaloglu E, Simsek H. A case of recurrent metastatic hepatocellular cancer controlled with immunotherapy and antiviral therapy following resection. Med Oncol. Dec 2009;26(4):501-505. 30. Kimura H, Fujibayashi S, Shimizu T, et al. Successful Total En Bloc Spondylectomy of T7 Vertebra for Hepatocellular Carcinoma Metastasis after Living Donor Liver Transplantation. Spine (Phila Pa 1976). Apr 17 2015. 31. Maccauro G, Muratori E, Sgambato A, et al. Bone metastasis in hepatocellular carcinoma. A report of five cases and a review of the literature. Chir Organi Mov. Jul-Sep 2005;90(3):297-302. 32. Melichar B, Voboril Z, Toupkova M, Dvorak J. Hepatocellular carcinoma presenting with bone metastasis. J Exp Clin Cancer Res. Sep 2002;21(3):433-436. 33. Miyamoto A, Umeshita K, Sakon M, et al. Advanced hepatocellular carcinoma with distant metastases, successfully treated by a combination therapy of alpha-interferon and oral tegafur/uracil. J Gastroenterol Hepatol. Dec 2000;15(12):1447-1451. 34. Nangolo HT, Roberto L, Segamwenge IL, Voigt A, Kidaaga F. Spinal cord compression: an unusual presentation of hepatocellular carcinoma. Pan Afr Med J. 2014;19:363. 35. Park JH, Park JH, Cho YH, Jeon SR, Kim CJ, Roh SW. Fiducial-free CyberKnife radiosurgery for residual metastatic spinal tumor after decompression and instrumentation. J Clin Neurosci. Nov 2012;19(11):1573-1575. 36. Reyes R, Peris P, Monegal A, Fuster D, Guanabens N. Vertebral "clover" scintigraphic image in a vertebral metastasis misdiagnosed with Paget's disease. Clin Rheumatol. Dec 2008;27(12):1585-1586. 37. Somerset H, Witt JP, Kleinschmidt-Demasters BK. Hepatocellular carcinoma metastases to the epidural space. Arch Pathol Lab Med. Dec 2009;133(12):1975-1980. 38. Tamaki K, Shimizu I, Urata M, et al. A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings. World J Gastroenterol. May 21 2007;13(19):2758-2760. 39. Toro A, Pulvirenti E, Manfre L, Di Carlo I. Sacroplasty in a patient with bone metastases from hepatocellular carcinoma. A case report. Tumori. Jan-Feb 2010;96(1):172-174. 40. Uemura A, Matsusako M, Numaguchi Y, et al. Percutaneous sacroplasty for hemorrhagic metastases from hepatocellular carcinoma. AJNR Am J Neuroradiol. Mar 2005;26(3):493-495. 41. Vargas J, Gowans M, Vandergrift WA, Hope J, Giglio P. Metastatic hepatocellular carcinoma with associated spinal cord compression. Am J Med Sci. Feb 2011;341(2):148-152. 42. Zhang D, Xu W, Liu T, et al. Surgery and prognostic factors of patients with epidural spinal cord compression caused by hepatocellular carcinoma metastases: retrospective study of 36 patients in a single center. Spine (Phila Pa 1976). Aug 1 2013;38(17):E1090-1095. 43. Cabibbo G, Maida M, Genco C, et al. Natural history of untreatable hepatocellular carcinoma: A retrospective cohort study. World journal of hepatology. Sep 27 2012;4(9):256-261. 44. Kim HJ, Lee HW. Important predictor of mortality in patients with end-stage liver disease. Clinical and molecular hepatology. Jun 2013;19(2):105-115. 45. Bauer H, Tomita K, Kawahara N, Abdel-Wanis ME, Murakami H. Surgical strategy for spinal metastases. Spine. May 15 2002;27(10):1124-1126. 46. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Spine. Feb 2001;26(3):298-306. 47. Ditunno JF, Jr., Young W, Donovan WH, Creasey G. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia. Feb 1994;32(2):70-80. 48. Lin CC, Chen PQ, Chen WJ, Chen LH. Prognosis of operative treatment for metastatic hepatocellular carcinoma of the spine. Clin Orthop Relat Res. Mar 2006;444:209-215.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy