Background/Aims
Advanced hepatocellular carcinoma (HCC) with multiple lung metastases has a poor
prognosis with no effective treatment having been established. This study evaluated the outcomes of systemic
chemotherapy for advanced HCC with multiple lung metastases. Methods: Between January 2000 and
December 2006, 68 patients were diagnosed with HCC presenting with multiple lung metastases. Sixteen
patients in the terminal stage, such as Child-Pugh grade ‘C’ or an Eastern Cooperative Oncology Group
performance status exceeding grade 2, were excluded from the analysis. The following treatment modalities
were applied: 26 patients received primary tumor treatment (transarterial chemoembolization or intra-arterial
chemotherapy) with systemic chemotherapy, 10 patients received primary treatment only, 8 patients received
systemic chemotherapy only, and 8 patients received highly supportive care. The treatment responses and
median survival times for the modalities were analyzed and compared. Results: The median age of the 52
analyzed patients (45 males) was 52.4 years. The most common etiology of HCC was chronic hepatitis B virus
infection (n=44, 84.6%) followed by hepatitis C virus infection (n=2, 3.8%), with the etiology being unknown
in 6 cases (11.5%). The treatment modality had no significant effect on the treatment response rate (P=0.432)
or median survival time (133, 66, 74, and 96 days for primary tumor treatment with systemic chemotherapy,
primary tumor treatment only, systemic chemotherapy only, and highly supportive care, respectively; P=0.067).
Conclusions
We found that systemic chemotherapy was not effective in treating HCC presenting with
multiple lung metastases. Improving the effectiveness of systemic treatment and selecting patients who would
benefit from such treatment remains a major challenge. (Korean J Hepatol 2008;14:360-370)
