Importance of achieving complete necrosis during the first treatment for hepatocellular carcinoma to prevent bone metastasis: A prospective study

Background and Aims: Recent advances in the treatment of hepatocellular car cinoma (HCC) have changed the importance of bone metastasis during the foll ow up of such patients. In the present study, we investigated risk factors for bone metastasis after treatment for HCC. Methods: Two hundred and two patients with HCC were diagnosed as free of bo ne metastasis by technecium 99m-methylene diphosphonate bone scintigraphy a nd were followed prospectively after treatment of the primary lesions (foll ow-up period 2-146 months; median 20 months). We statistically analyzed the risk factors for bone metastasis using the clinical characteristics at the time of first treatment. Results: Multiple tumors (P<0.005), main tumor size >5 cm in diameter (P<0. 005), the presence of distant metastasis (P<0.005), elevation of serum alph a -fetoprotein (>100 ng/mL; P<0.05), chemotherapy (P<0.05) and insufficient therapeutic response (P<0.0005) were identified as risk factors for bone m etastasis by univariate analyses. Insufficient therapeutic response and mai n tumor size >5 cm in diameter (both P<0.05) were identified as independent predisposing factors for bone metastasis. Conclusions: Complete necrosis of primary HCC during the first treatment is important to prevent subsequent bone metastasis. (C) 2001 Blackwell Scienc e Asia Pty Ltd.