A cohort study on efficacy and safety of treatment modalities for resectable hepatocellular carcinoma with extrahepatic metastasis
- 1Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, China
Abstract
Background and aims
This study compared survival outcomes, prognostic factors, and safety between hepatectomy and interventional and systemic therapy among patients with hepatocellular carcinoma (HCC) with resectable intrahepatic lesions and extrahepatic metastasis.Methods
A total of 490 patients were enrolled between January 2014 and December 2024 and were divided into two groups based on treatment modality: hepatectomy group (n = 152) and interventional and systemic therapy group (n = 338). Overall survival (OS) and event-free survival (EFS) were analyzed via the Kaplan-Meier method and compared using the log-rank test. Propensity score matching (PSM) was applied to reduce baseline differences between the two groups. Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards regression analyses. Adverse events were evaluated using the Clavien-Dindo classification and Common Terminology Criteria for Adverse Events (version 5.0).Results
Hepatectomy yielded superior 1-, 3-, and 5-year OS rates (58.4%, 30.5%, and 26.0%, respectively, vs. 48.6%, 20.7%, and 11.9%, respectively) and longer median OS (17 vs. 12 months), and this benefit persisted after PSM. However, the EFS benefit was lost after PSM. Sensitivity analysis excluding "other" metastases (adjacent organ invasion) attenuated the OS benefit but preserved the EFS benefit. Subgroup analyses highlighted treatment effect heterogeneity by metastasis site, age, prealbumin level, and portal vein tumor thrombosis (PVTT). Multivariate analysis identified sex (male), prealbumin ≥ 200 mg/L, and PVTT as independent predictors of OS.Conclusions
Hepatectomy might provide a survival benefit over interventional and systemic therapy in carefully selected patients with resectable HCC and extrahepatic metastasis, particularly those with lung-only metastasis, preserved liver function, and no PVTT.
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BibTeX
@article{yang2026cohort,
title = {{A cohort study on efficacy and safety of treatment modalities for resectable hepatocellular carcinoma with extrahepatic metastasis}},
author = {Tai-xin Yang and Zhan Lu and Jie Zhang and Ri-wei Lao and Tai Luo and Yang-song Lin and Shu-ying Xian and Yue Deng and Hong-yun Qin and Bang-de Xiang and Wen-feng Gong},
journal = {ILIVER},
year = {2026},
month = oct,
doi = {10.1016/j.iliver.2026.100273},
url = {https://europepmc.org/article/PMC/PMC13717877},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A cohort study on efficacy and safety of treatment modalities for resectable hepatocellular carcinoma with extrahepatic metastasis
AU - Tai-xin Yang
AU - Zhan Lu
AU - Jie Zhang
AU - Ri-wei Lao
AU - Tai Luo
AU - Yang-song Lin
AU - Shu-ying Xian
AU - Yue Deng
AU - Hong-yun Qin
AU - Bang-de Xiang
AU - Wen-feng Gong
PY - 2026
DA - 2026/10/02
JO - ILIVER
DO - 10.1016/j.iliver.2026.100273
UR - https://europepmc.org/article/PMC/PMC13717877
AB - Background and aims This study compared survival outcomes, prognostic factors, and safety between hepatectomy and interventional and systemic therapy among patients with hepatocellular carcinoma (HCC) with resectable intrahepatic lesions and extrahepatic metastasis.Methods A total of 490 patients were enrolled between January 2014 and December 2024 and were divided into two groups based on treatment modality: hepatectomy group (n = 152) and interventional and systemic therapy group (n = 338). Overall survival (OS) and event-free survival (EFS) were analyzed via the Kaplan-Meier method and compared using the log-rank test. Propensity score matching (PSM) was applied to reduce baseline differences between the two groups. Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards regression analyses. Adverse events were evaluated using the Clavien-Dindo classification and Common Terminology Criteria for Adverse Events (version 5.0).Results Hepatectomy yielded superior 1-, 3-, and 5-year OS rates (58.4%, 30.5%, and 26.0%, respectively, vs. 48.6%, 20.7%, and 11.9%, respectively) and longer median OS (17 vs. 12 months), and this benefit persisted after PSM. However, the EFS benefit was lost after PSM. Sensitivity analysis excluding "other" metastases (adjacent organ invasion) attenuated the OS benefit but preserved the EFS benefit. Subgroup analyses highlighted treatment effect heterogeneity by metastasis site, age, prealbumin level, and portal vein tumor thrombosis (PVTT). Multivariate analysis identified sex (male), prealbumin ≥ 200 mg/L, and PVTT as independent predictors of OS.Conclusions Hepatectomy might provide a survival benefit over interventional and systemic therapy in carefully selected patients with resectable HCC and extrahepatic metastasis, particularly those with lung-only metastasis, preserved liver function, and no PVTT.
SN - 2772-9478
ER -