Format

Send to

Choose Destination
PLoS One. 2014 Aug 29;9(8):e105268. doi: 10.1371/journal.pone.0105268. eCollection 2014.

Natural history of malignant bone disease in hepatocellular carcinoma: final results of a multicenter bone metastasis survey.

Author information

1
Medical Oncology Unit - University Campus Bio-Medico, Rome, Italy.
2
Medical Oncology Unit, Cardarelli Hospital, Naples, Italy.
3
Liver Unit, Cardarelli Hospital, Naples, Italy.
4
Medical Oncology Unit, 'San Giovanni di Dio' Frattamaggiore Hospital, Frattammaggiore, Italy.
5
Medical Oncology Unit, Treviglio-Caravaggio Hospital, Treviglio, Italy.
6
Medical Oncology Unit, Fondazione Poliambulanza, Brescia, Italy.
7
Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
8
Department of Medical Oncology, University of Rome La Sapienza, Santa Andrea Hospital, Rome, Italy.
9
Section of Medical Oncology, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
10
Clinica di Oncologia Medica, AOU Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy.
11
Medical Oncology Unit - Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
12
Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy.
13
Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS- Osteoncology and Rare Tumors Center, Meldola, Italy.
14
Division of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
15
Medical Oncology Unit - Hospital of Lecce, Lecce, Italy.
16
Department of Oncology, Gradenigo Hospital and Gruppo Piemontese Sarcomi, Turin, Italy.
17
Unit of Gastrointestinal and Neuroendocrine Tumor, European Institute of Oncology, Milan, Italy.
18
Department of Clinical and Specialist Sciences, Urology, Polytechnic University of the Marche Region, AOU Ospedali Riuniti Umberto I-GM Lancisi and G Salesi, Ancona, Italy.
19
Medical Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
20
Medical Oncology Unit - S.G. Moscati Hospital ASL TA/1, Taranto, Italy.
21
Medical Oncology Unit - Hospital Careggi, Florence, Italy.
22
Medical Oncology Department & Breast Unit - Hospital of Brindisi and Medical Oncology Department - European Institute of Oncology, Milan, Italy.
23
Medical Oncology, A.O. "Ospedali Riuniti Marche Nord", Presidio S. Salvatore, Pesaro, Italy.
24
Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari, Bari, Italy.
25
U.O. Infectious Disease, P.O. Bisceglie, Bisceglie, Italy.
26
Centro di Riferimento Oncologico della Basilicata IRCCS, Rionero in Vulture, Italy.
27
Medical Oncology unit - Hospital of Aosta, Aosta, Italy.
28
Interventional Radiology Unit with Integrated Section of Translational Medical Oncology - National Cancer Institute "Giovanni Paolo II", Bari, Italy.
29
Medical Oncology Unit - National Cancer Institute "Giovanni Paolo II", Bari, Italy.

Abstract

BACKGROUND:

Bone is an uncommon site of metastasis in patients with advanced hepatocellular carcinoma (HCC). Therefore, there are few studies concerning the natural history of bone metastasis in patients with HCC.

PATIENTS AND METHODS:

Data on clinicopathology, survival, skeletal-related events (SREs), and bone-directed therapies for 211 deceased HCC patients with evidence of bone metastasis were statistically analyzed.

RESULTS:

The median age was 70 years; 172 patients were male (81.5%). The median overall survival was 19 months. The median time to the onset of bone metastasis was 13 months (22.2% at HCC diagnosis); 64.9% patients had multiple bone metastases. Spine was the most common site of bone metastasis (59.7%). Most of these lesions were osteolytic (82.4%); 88.5% of them were treated with zoledronic acid. At multivariate analysis, only the Child Score was significantly correlated with a shorter time to diagnosis of bone metastases (p = 0.001, HR = 1.819). The median survival from bone metastasis was 7 months. At multivariate analysis, HCC etiology (p = 0.005), ECOG performance status (p = 0.002) and treatment with bisphosphonate (p = 0.024) were associated with shorter survival after bone disease occurrence. The site of bone metastasis but not the number of bone lesions was associated with the survival from first skeletal related event (SRE) (p = 0.021) and OS (p = 0.001).

CONCLUSIONS:

This study provides a significant improvement in the understanding the natural history of skeletal disease in HCC patients. An early and appropriate management of these patients is dramatically needed in order to avoid subsequent worsening of their quality of life.

PMID:
25170882
PMCID:
PMC4149423
DOI:
10.1371/journal.pone.0105268
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center