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Surgical Outcome of Spinal Hepatocellular Carcinoma Metastases

Kim, Chi Heon MD, PhD*‡§; Chung, Chun Kee MD, PhD*‡§; Jahng, Tae-Ahn MD, PhD*‡§; Kim, Hyun Jib MD, PhD*¶

doi: 10.1227/NEU.0b013e3182098c18
Research-Human-Clinical Studies

BACKGROUND: Spinal hepatocellular carcinoma (HCC) metastases are increasing with improved survival of patients with HCC. However, its treatment outcome, particularly regarding functional outcome, has not been adequately investigated.

OBJECTIVE: To present the surgical outcome of spinal HCC metastases and demonstrate prognostic factors for survival and ambulation time.

METHODS: Thirty-three patients (30 males, 3 females) were retrospectively reviewed. Child-Pugh classification was used to assess hepatic function. Preoperatively, 19 patients could ambulate (group A) and 14 patients could not (group B). Preoperatively, 18 patients received conventional fractionated radiotherapy.

RESULTS: The spinal metastases were removed to achieve sufficient neural decompression. If destabilization developed, instrumentation and/or vertebroplasty were performed. Postoperatively, conventional radiotherapy was administered to 13 patients. Patients survived for 203 ± 31 days. Child-Pugh classification and preoperative/postoperative ambulatory ability were correlated with survival time, with Child-Pugh classification being the most significant factor (hazard ratio, 3.75; 95% confidence interval: 1.38-10.22). After the operation, ambulatory ability was maintained in all group A patients and was recovered in 4 in group B. Twenty-three patients could ambulate for 285 ± 62 days. Preoperative ambulatory status and Child-Pugh classification were correlated with a longer ambulatory period, with preoperative ambulatory status most significant (hazard ratio, 8.62; 95% confidence interval: 2.39-31.04). Patients died 81 ± 71 days after the loss of ambulatory ability, regardless of postoperative ambulatory status.

CONCLUSION: In spinal HCC metastasis, ambulatory status and hepatic function were significantly correlated with survival and ambulation time. Both ambulatory status and hepatic function should be considered in the selection of surgical candidates.

*Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea; ‡Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea; §Clinical Research Institute, Seoul National University Hospital, ¶Department of Neurosurgery, Bundang Seoul National University Hospital, Seoul, South Korea

Received, January 4, 2010.

Accepted, June 29, 2010.

Correspondence: Chun Kee Chung, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, 110-744, South Korea. E-mail:

Copyright © by the Congress of Neurological Surgeons