Skeletal metastases from hepatocellular carcinoma (HCC) have been infrequently reported in the literature outside of Asian populations. Recent progress in HCC, including advancements in diagnostic imaging, has led to increased patient survival time, and thus an increased potential to develop secondary skeletal metastasis. We anticipate that this increased prevalence will be reflected in HCC populations throughout North American institutions.
We conducted a retrospective review of patients from 1985 to 2013 who presented with pathologically confirmed skeletal metastasis from HCC. Presentation of metastasis, disease progression, survival rate, and utilization of interventions and their effect on morbidity and mortality were identified from patients’ medical records.
We identified a total of eight HCC patients with skeletal metastasis within this timeframe. Of these eight patients, four had no prior HCC diagnosis, and their symptomatic skeletal metastasis was their initial cause for presentation. Surgical intervention was indicated for two of these patients, and two were treated conservatively with external beam radiation, chemotherapy, or both. Four other patients had preexisting diagnosis of HCC before presenting with skeletal lesions. Surgical intervention was indicated in one patient, while the remaining three were treated exclusively with conservative measures, either external beam radiation or chemotherapy.
From this review, we found skeletal metastasis from HCC to consistently be a late manifestation of the disease. Treatment modalities of skeletal metastasis were appropriately implemented solely as palliative measures. Utilization of Mirel’s criteria and more temporizing means of fixation are relevant in determining the manner and means of surgical intervention.