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Abstract Details
Natural history of malignant bone disease in hepatocellular carcinoma: final results of a multicenter bone metastasis survey
Author information
1Medical Oncology Unit - University Campus Bio-Medico, Rome, Italy.
2Medical Oncology Unit, Cardarelli Hospital, Naples, Italy.
3Liver Unit, Cardarelli Hospital, Naples, Italy.
4Medical Oncology Unit, 'San Giovanni di Dio' Frattamaggiore Hospital, Frattammaggiore, Italy.
5Medical Oncology Unit, Treviglio-Caravaggio Hospital, Treviglio, Italy.
6Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy.
7Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
8Department of Medical Oncology, University of Rome La Sapienza, Santa Andrea Hospital, Rome, Italy.
9Section of Medical Oncology, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
10Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy.
11Medical Oncology Unit - Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
12Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy.
13Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS- Osteoncology and Rare Tumors Center, Meldola, Italy.
14Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
15Medical Oncology Unit - Hospital of Lecce, Lecce, Italy.
16Department of Oncology, Gradenigo Hospital and Gruppo Piemontese Sarcomi, Turin, Italy.
17Unit of Gastrointestinal and Neuroendocrine Tumor, European Institute of Oncology, Milan, Italy.
18Department of Clinical and Specialist Sciences, Urology, Polytechnic University of the Marche Region, AOU Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy.
19Medical Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
20Medical Oncology Unit - S.G. Moscati Hospital ASL TA/1, Taranto, Italy.
21Medical Oncology Unit - Hospital Careggi, Florence, Italy.
22Medical Oncology Department & Breast Unit - Hospital of Brindisi and Medical Oncology Department - European Institute of Oncology, Milan, Italy.
23Medical Oncology, A.O. "Ospedali Riuniti Marche Nord", Presidio S. Salvatore, Pesaro, Italy.
24Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari, Bari, Italy.
25U.O. Infectious Disease, P.O. Bisceglie, Bisceglie, Italy.
26Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy.
27Medical Oncology unit - Hospital of Aosta, Aosta, Italy.
28Interventional Radiology Unit with Integrated Section of Translational Medical Oncology - National Cancer Institute "Giovanni Paolo II", Bari, Italy.
29Medical Oncology Unit - National Cancer Institute "Giovanni Paolo II", Bari, Italy.
Abstract
BACKGROUND:
Bone is an uncommon site of metastasis in patients with advanced hepatocellular carcinoma (HCC). Therefore, there are few studies concerning the natural history of bone metastasis in patients with HCC.
PATIENTS AND METHODS:
Data on clinicopathology, survival, skeletal-related events (SREs), and bone-directed therapies for 211 deceased HCC patients with evidence of bone metastasis were statistically analyzed.
RESULTS:
The median age was 70 years; 172 patients were male (81.5%). The median overall survival was 19 months. The median time to the onset of bone metastasis was 13 months (22.2% at HCC diagnosis); 64.9% patients had multiple bone metastases. Spine was the most common site of bone metastasis (59.7%). Most of these lesions were osteolytic (82.4%); 88.5% of them were treated with zoledronic acid. At multivariate analysis, only the Child Score was significantly correlated with a shorter time to diagnosis of bone metastases (p = 0.001, HR = 1.819). The median survival from bone metastasis was 7 months. At multivariate analysis, HCC etiology (p = 0.005), ECOG performance status (p = 0.002) and treatment with bisphosphonate (p = 0.024) were associated with shorter survival after bone disease occurrence. The site of bone metastasis but not the number of bone lesions was associated with the survival from first skeletal related event (SRE) (p = 0.021) and OS (p = 0.001).
CONCLUSIONS:
This study provides a significant improvement in the understanding the natural history of skeletal disease in HCC patients. An early and appropriate management of these patients is dramatically needed in order to avoid subsequent worsening of their quality of life.