Effects of Clinical and Tumor Characteristics on Survival in Patients with Hepatocellular Carcinoma with Bone Metastasis

Abstract

Muhammet Ozer,1 Suleyman Yasin Goksu,2 Rick Y Lin,3 Ruveyda Ayasun,4 Doga Kahramangil,5 Sherise C Rogers,5,6 Jesus C Fabregas,5,6 Brian H Ramnaraign,5,6 Thomas J George,5,6 Michael Feely,7 Roniel Cabrera,8 Sergio Duarte,9 Ali Zarrinpar,9 Ilyas Sahin5,6 1Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; 2Division of Hematology/Oncology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; 3Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA; 4Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA; 5Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA; 6University of Florida Health Cancer Center, Gainesville, FL, USA; 7Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA; 8Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA; 9Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USACorrespondence: Ilyas Sahin, Department of Medicine, University of Florida, Gainesville, FL, 32608, USA, Email [email protected]: Advanced hepatocellular carcinoma (HCC) generally has a dismal prognosis. Bone metastases from HCC are infrequent, with a poorer prognosis. However, the survival influencing factors are not yet well understood.Aim: The aim of the present study was to assess the clinical features and tumor characteristics of HCC patients with bone metastasis.Methods: A cohort of 170,576 adult patients with HCC was studied using the National Cancer Database (NCDB) spanning from 2010 to 2019, and within this group, 5285 patients (3.1%) were diagnosed with bone metastasis. We performed the Kaplan–Meier method to calculate the median overall survival (OS). We included demographics (age at diagnosis, gender, race, insurance status), comorbidity score, and treatment characteristics.Results: Of a total of 5285 HCC patients with bone metastasis, 86.2% were male and 61.2% were non-Hispanic white. Most patients (55.1%) were below 65, and 89% had a total Charlson-Deyo comorbidity score of under 3. Among patients with known tumor grade, 24.8% had well-differentiated tumors, and 36.1% had poorly differentiated tumors. Chemotherapy was administrated to 39.5% of patients. In univariate analysis, patients with well-differentiated tumors had better OS compared to poorly differentiated tumors (5.4 months vs 3.0 months, p = 0.001). Patients who received single or multiagent chemotherapy were significantly associated with improved OS compared to patients who did not receive chemotherapy (7.0 and 8.5 months vs 1.94 months, respectively). We also found mortality difference between age, comorbidity scores, facility types and race groups.Conclusion: In this cohort analysis of NCDB data, we found better OS in treatment receipt, lower tumor grade, younger age, non-Hispanic Black and Hispanic race, treatment at academic facility and lower comorbidity score in HCC patients with bone metastasis. The study results may have a consequential impact on the treatment decisions for HCC patients with bone metastasis.Keywords: hepatocellular carcinoma, HCC, bone metastasis

Keywords

• hepatocellular carcinoma
• hcc
• bone metastasis