PULMONARY METASTASIS OF HEPATOCELLULAR-CARCINOMA ASSOCIATED WITH TRANSARTERIAL CHEMOEMBOLIZATION

Recent advances in both diagnosis and treatment of hepatocellular carc inoma have improved the prognosis and changed the clinical significanc e of the subsequently increasing distant metastases. Pulmonary metasta sis of hepatocellular carcinoma associated with transcatheter arterial chemoembolization has rarely been reported. Methods: To evaluate whet her transcatheter arterial chemoembolization increases the risk of pul monary metastasis of hepatocellular carcinoma, 230 patients were studi ed, Among them, 156 received transcatheter arterial chemoembolization with an interval of 12-16. weeks, the remaining 74 cases refused trans catheter arterial chemoembolization and received only conservative tre atment, All patients were followed up with chest x-ray films taken bef ore transcatheter arterial chemoembolization, during admission or in t he out-patient department, The mean follow-up interval was 3.37 +/- 1. 51 months. Results: Pulmonary metastasis was found in 25.6% (40/156) a nd 8.1% (6/74) of the patients with and without transcatheter arterial chemoembolization (p=0.002), The median interval between initial diag nosis and pulmonary metastasis was 3.39 +/- 0.08 and 11.72 +/- 2.91 mo nths among patients with and without transcatheter arterial chemoembol ization (p=0.001). The mean age, sex, existence of cirrhosis, severity of cirrhosis, presence of collateral arterial circulation, amount of lipiodol and agent of anti-cancer drugs were not associated with the d evelopment of lung metastasis. However, factors predisposing to lung m etastasis included: solitary tumor with tumor size >10 cm, multiple tu mors with main tumor >5 cm or diffuse hepatocellular carcinoma, intrah epatic portal vein thrombosis, arterioportal or arteriovenous shunt, a nd the presence of incomplete tumor necrosis after transcatheter arter ial chemoembolization (especially combined with necrotic area >50% mai n tumor size). Conclusions: Pulmonary metastasis associated with trans catheter arterial chemoembolization has a strong adverse impact on pat ient survival. (C) Journal of Hepatology.