Clinical

Resection of lung metastases may help in liver cancer

Last Updated: 2010-04-15 9:22:29 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Resection of pulmonary metastases from hepatocellular carcinoma can be safe and beneficial in selected patients, Korean researchers say in a March 29th online paper in Lung Cancer.

"Some tumors seem to spread only to a specific organ (key organ) without spreading to the other part of the body," co-author Dr. Young Tae Kim told Reuters Health by email. The lung could be that key organ for liver cancer, Dr. Kim added.

Because the incidence of liver cancer is high in Korea, "we experience many patients who have a metastasis to the lung," Dr. Kim said.

For their recent paper, Dr. Kim at Seoul National University Hospital and colleagues reviewed data on 41 liver cancer patients who had resection of pulmonary metastases.

All had controllable (or controlled) liver lesions, adequate pulmonary function, and no other distant metastases.

Twenty-four patients had no liver lesions when they underwent lung surgery. In these patients, the median time from complete remission of hepatocellular carcinoma to lung resection was 11 months. The other 17 patients had stable liver disease.

Twenty-two patients (53.7%) had multiple pulmonary lesions, and 6 had bilateral resections.

During a median of 25 months of follow-up, hepatocellular carcinoma recurred in 33 patients, including 9 with recurrence only in the liver, another 9 with recurrence only in the lung, and 4 with new lesions in both the liver and the lung. Other sites of recurrence included the brain and the chest wall lymph nodes.

The median survival after pulmonary resection was 77 months. At 5 years, the overall survival rate was 66.9% -- but almost 75% of patients recurred within 2 years.

The median time from primary pulmonary resection to recurrence was 8.5 months.

In the 24 patients who had no disease in the liver when they had lung surgery, the disease-free survival rate at 5 years was only 24.5%.

The researchers tried to identify factors that would predict overall survival, but only extrapulmonary/extrahepatic metastases at the time of pulmonary resection had a significant impact (p = 0.006). None of the other factors they analyzed - gender, alpha fetoprotein level before or after surgery, a shorter disease-free interval, bilateral vs unilateral lung metastases, tumor size, lymph node status, or the presence of multiple lung metastases at the time of initial pulmonary resection - was significantly related to survival.

Therefore, Dr. Kim concluded, "if the metastases are confined only to the lung, we may be able to cure the patients by resecting lungs. If the tumor has already spread to other part of the body -- other than lung and liver - their survival is poor."

Lung Cancer 2010.