Efficacy of Local Therapy for Oligometastatic Hepatocellular Carcinoma: A Propensity Score Matched Analysis

Kangpyo Kim,1 Tae Hyung Kim,1 Tae Hyun Kim,2 Jinsil Seong1 1Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Statistics, University of Chicago, Chicago, IL, USACorrespondence: Jinsil SeongDepartment of Radiation Oncology, Yonsei University College of Medicine, Seoul, 03722, Republic of KoreaTel + 82-2-2228-8111Fax + 82-2-2227-7823Email jsseong@yuhs.acPurpose: With respect to various solid cancers, patients with oligometastasis may benefit from local therapy. However, this approach is not widely accepted for hepatocellular carcinoma. This study investigated the efficacy of local therapy for oligometastatic lesions in patients with hepatocellular carcinoma.Patients and Methods: The study included 69 hepatocellular carcinoma patients presenting with oligometastasis to the lung. Characteristics of the patients and treatment options for metastatic lesions were reviewed, and a survival analysis was performed. After propensity score matching, overall survival and progression-free survival were calculated from the time of pulmonary metastasis detection. Factors predicting prognosis were analyzed using a multivariate Cox regression analysis.Results: After propensity score matching, 58 patients with Child-Pugh grade A disease were selected. Among them, 22 patients were treated with systemic therapy alone while 36 patients received local therapy or a combination of local and systemic therapies for metastatic lesions. Survival rates were higher in patients receiving local therapy than in those receiving systemic therapy (2-year overall survival rate, 66.6 vs 31.2%, p< 0.001; 2-year progression-free survival rate, 47.0 vs 10.6%, p=0.005). In the multivariate Cox regression analysis, alpha-fetoprotein levels less than 400 ng/mL and the use of local therapy for metastatic lesions were found to be significant favorable prognostic factors.Conclusion: Local therapy for metastatic lesions improved the oncologic outcomes of patients with hepatocellular carcinoma with pulmonary oligometastasis.Keywords: HCC, local ablation therapy, oligometastasis, propensity score matching