Treatment strategies for hepatocellular carcinoma with extrahepatic metastasis

Extrahepatic metastasis(EHM)of hepatocellular carcinoma(HCC)has increasingly been seen due to improved survival with effective management of intrahepatic lesions.The presence of EHM indicates an advanced stage of HCC,for which systemic therapy serves as the standard treatment modality.Since the approval of Sorafenib as the first systemic agent in 2007,it took almost a decade to show its efficacy in both first and further lines of setting until the landscape of systemic drugs was finally expanded.Moreover,with inspiring results from immunotherapy trials in HCC,it appears that the introduction of immunotherapy may lead to an evolution in the portfolio of HCC treatment.Although the locoregional approach in the management of EHM is not recommended for advancedstage HCC,efforts have been made to demonstrate its efficacy in symptom relief and potential benefit for overall survival.This review provides a summary of recent updates of the systemic agents in the treatment of advanced HCC,with an emphasis on aggressive locoregional management of EHM by various treatment modalities.

Concurrent hepatocellular carcinoma metastasis to stomach,colon,and brain:A case report

BACKGROUND Extrahepatic metastasis(EHM)from hepatocellular carcinoma(HCC)occurs in 10%–15%of cases following initial treatment.The most frequent sites of EHM are the lung,lymph nodes,and bone.Gastrointestinal or brain metastasis from HCC is rarely reported.Here,we report a rare case of concurrent HCC metastases to the stomach,colon,and brain.CASE SUMMARY A 72-year-old male with a history of alcohol induced HCC presented with multiple intrahepatic recurrences and tumorous lesions in the stomach and ascending colon.Three years earlier,he underwent right hemihepatectomy,and 1 year ago,he had a video-assisted thoracoscopic wedge resection for pulmonary metastasis of HCC.We decided on surgical resection of the new metastases because of massive gastric bleeding and concern for possible colonic obstruction.The patient underwent gastric wedge resection and right hemicolectomy.Two weeks later,the patient developed dysarthria and mild cognitive disorder.Magnetic resonance imaging of the brain revealed a left frontal lobe lesion,and he underwent resection of a metastatic brain tumor.Unfortunately,he died 6 weeks after the last surgery due to hepatorenal syndrome.CONCLUSION Decision of surgery was carefully recommended in this case and may extend survival in other metastatic HCC patients with well-preserved hepatic function.

Intussusception due to hematogenous metastasis of hepatocellular carcinoma to the small intestine:A case report

BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.