The clinical features and prognostic factors of hepatocellular carcinoma patients with spinal metastasis

Objective Hepatocellular carcinoma is the most common malignancy in Taiwan, and spinal metastasis is a serious complication in cancer patients. In thi s study, we aimed to delineate the clinical features, evaluate the radiothe rapy response and analyse the prognostic features in hepatocellular carcino ma subjects with spinal metastasis. Methods From 1981 to 1997, 102 patients with spinal metastasis were enrolle d, taken from the 5887 documented hepatocellular carcinoma patients treated at Taipei Veterans General Hospital. All the clinical and laboratory data were recorded, including: age; gender; liver biochemistry; tumour character istics; Child-Pugh's score; performance status; number and location of vert ebral metastasis; motor capacity; neurological symptoms and signs; response to radiotherapy of the spinal lesion; and survival. Prognostic factors in hepatocellular carcinoma patients with spinal metastasis were analysed usin g Cox's regression model. Results The most common symptoms in hepatocellular carcinoma patients with spinal metastasis were lower back pain (74.5%), thoracic numbness (52.9%) a nd lower limb weakness (51.0%). Of the 102 patients, 84 received palliative radiotherapy using 3000 cGy for spinal lesions. Of these 84 patients, 32.1 % showed a complete response, 26.2% a partial response and 41.7% a non-resp onse to the radiotherapy. Multivariate Cox's regression analysis revealed t hat responsive radiotherapy (complete response + partial response) and good performance status (score less than or equal to 2) were significant positi ve prognostic factors for survival in hepatocellular carcinoma patients wit h spinal metastasis. Conclusions Responsive radiotherapy can improve a hepatocellular carcinoma patient's quality of life by ameliorating the neurological condition and re lieving pain, and can prolong survival in hepatocellular carcinoma patients with spinal metastasis. (C) 2001 Lippincott Williams & Wilkins.