Clinical outcomes of systemic chemotherapy in hepatocellular carcinoma patients with multiple lung metastases

Advanced hepatocellular carcinoma (HCC) with multiple lung metastases has a poor prognosis with no effective treatment having been established. This study evaluated the outcomes of systemic chemotherapy for advanced HCC with multiple lung metastases.Between January 2000 and December 2006, 68 patients were diagnosed with HCC presenting with multiple lung metastases. Sixteen patients in the terminal stage, such as Child-Pugh grade ;C' or an Eastern Cooperative Oncology Group performance status exceeding grade 2, were excluded from the analysis. The following treatment modalities were applied: 26 patients received primary tumor treatment (transarterial chemoembolization or intra-arterial chemotherapy) with systemic chemotherapy, 10 patients received primary treatment only, 8 patients received systemic chemotherapy only, and 8 patients received highly supportive care. The treatment responses and median survival times for the modalities were analyzed and compared.The median age of the 52 analyzed patients (45 males) was 52.4 years. The most common etiology of HCC was chronic hepatitis B virus infection (n=44, 84.6%) followed by hepatitis C virus infection (n=2, 3.8%), with the etiology being unknown in 6 cases (11.5%). The treatment modality had no significant effect on the treatment response rate (P=0.432) or median survival time (133, 66, 74, and 96 days for primary tumor treatment with systemic chemotherapy, primary tumor treatment only, systemic chemotherapy only, and highly supportive care, respectively; P=0.067).We found that systemic chemotherapy was not effective in treating HCC presenting with multiple lung metastases. Improving the effectiveness of systemic treatment and selecting patients who would benefit from such treatment remains a major challenge.