International Journal of Clinical Oncology

, Volume 23, Issue 5, pp 886–893 | Cite as

Treatment outcomes of patients with spinal metastases derived from hepatocellular carcinoma

  • Hiroshi Uei
  • Yasuaki Tokuhashi
  • Masafumi Maseda
Original Article



The prognosis of hepatocellular carcinoma (HCC) used to be poor, but it has recently improved, which has meant that clinicians have greater opportunity to treat spinal metastases and the associated epidural spinal cord compression. However, there have been few systematic functional studies about HCC-derived spinal metastases. The treatment outcomes of surgical treatment for HCC-derived metastatic spinal tumors were investigated.


The post-treatment survival period and pain, paralysis, and disturbance of activities of daily living (ADL) were investigated in 60 patients (surgery 25, conservative treatment 35).


The mean post-treatment survival period was 7.4 ± 8.2 months (range 0.3–36 months). Univariate analysis indicated that the following factors influenced survival: the patient’s general condition, presence/absence of major internal organ metastasis, serum albumin level, Child–Pugh classification, surgical treatment for spinal metastasis, and bone-modifying agent treatment. In the multivariate analysis of these 6 items, 3 significant factors were extracted: the patient’s general condition, the serum albumin level, and bone-modifying agent treatment. Pain significantly improved in both groups (p < 0.001). Paralysis did not change significantly in the surgical group (p = 0.575), but it was significantly aggravated in the conservative treatment group (p = 0.047). The ADL abilities of the surgical group improved significantly (p < 0.001).


Most patients exhibited poor survival. In the conservative treatment group, paralysis was significantly aggravated, and little improvement was seen in the patients’ ADL abilities. In the surgical group, the patients’ ADL abilities improved significantly, but their paralysis did not. Therefore, surgery should be actively performed for HCC-derived spinal metastasis whenever it is indicated.


Metastatic spinal tumor Hepatocellular carcinoma Treatment outcome Barthel index Survival period Activities of daily living 



We would like to thank all of the members of staff at Nihon University Itabashi Hospital.


No support.

Compliance with ethical standards

Conflict of interest

No author has any conflict of interest.

Ethical approval

IRB approval from Nihon University Itabashi Hospital: RK-11209-8.


  1. 1.
    Morgen SS, Lund-Andersen C, Larsen CF et al (2013) Prognosis in patients with symptomatic metastatic spinal cord compression: survival in different cancer diagnosis in a cohort of 2321 patients. Spine 38:1362–1367CrossRefGoogle Scholar
  2. 2.
    Tralhao JG, Dagher I, Lino T et al (2007) Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 33:746–751Google Scholar
  3. 3.
    Sohn S, Kim J, Chung CK et al (2016) A nationwide epidemiological study of newly diagnosed spine metastasis in the adult Korean population. Spine J Off J N Am Spine Soc 16:937–945CrossRefGoogle Scholar
  4. 4.
    Chang UK, Kim MS, Han CJ et al (2014) Clinical result of stereotactic radiosurgery for spinal metastasis from hepatocellular carcinoma: comparison with conventional radiation therapy. J Neurooncol 119:141–148CrossRefGoogle Scholar
  5. 5.
    Chen H, Xiao J, Yang X et al (2010) Preoperative scoring systems and prognostic factors for patients with spinal metastases from hepatocellular carcinoma. Spine 35:E1339–E1346CrossRefGoogle Scholar
  6. 6.
    Rades D, Dahlke M, Janssen S et al (2015) Radiation therapy for metastatic spinal cord compression in patients with hepatocellular carcinoma. In vivo (Athens Greece) 29:749–752Google Scholar
  7. 7.
    Zhang D, Xu W, Liu T et al (2013) Surgery and prognostic factors of patients with epidural spinal cord compression caused by hepatocellular carcinoma metastases: retrospective study of 36 patients in a single center. Spine 38:E1090–E1095CrossRefGoogle Scholar
  8. 8.
    Tokuhashi Y, Matsuzaki H, Oda H et al (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191CrossRefGoogle Scholar
  9. 9.
    Tokuhashi Y, Matsuzaki H, Toriyama S et al (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15:1110–1113CrossRefGoogle Scholar
  10. 10.
    Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65PubMedGoogle Scholar
  11. 11.
    Prodinger B, O’Connor RJ, Stucki G et al (2017) Establishing score equivalence of the Functional Independence Measure motor scale and the Barthel index, utilising the international classification of functioning, disability and health and Rasch measurement theory. J Rehabil Med 49: 416–422CrossRefGoogle Scholar
  12. 12.
    Vargas J, Gowans M, Vandergrift WA et al (2011) Metastatic hepatocellular carcinoma with associated spinal cord compression. Am J Med Sci 341:148–152CrossRefGoogle Scholar
  13. 13.
    Jemal A, Center MM, DeSantis C et al (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 19:1893–1907CrossRefGoogle Scholar
  14. 14.
    Hsiao SY, Chen SF, Chang CC et al (2011) Central nervous system involvement in hepatocellular carcinoma: clinical characteristics and comparison of intracranial and spinal metastatic groups. J Clin Neurosci Off J Neurosurg Soc Australas 18:364–368Google Scholar
  15. 15.
    Santini D, Pantano F, Riccardi F et al (2014) Natural history of malignant bone disease in hepatocellular carcinoma: final results of a multicenter bone metastasis survey. PLoS One 9:e105268CrossRefGoogle Scholar
  16. 16.
    Goodwin CR, Yanamadala V, Ruiz-Valls A et al (2016) A systematic review of metastatic hepatocellular carcinoma to the spine. World Neurosurg 91(510–517):e514Google Scholar
  17. 17.
    Ryo H, Sakai H, Yoneda S et al (1998) Bone metastasis of primary lung cancer. Nihon Kokyuki Gakkai zasshi J Jpn Respiratory Soc 36:317–322Google Scholar
  18. 18.
    Kim HJ, Lee HW (2013) Important predictor of mortality in patients with end-stage liver disease. Clin Mol Hepatol 19:105–115CrossRefGoogle Scholar
  19. 19.
    Kogure T, Ueno Y, Kimura O et al (2009) A novel third generation bisphosphonate, minodronate (YM529), prevented proliferation and migration of hepatocellular carcinoma cells through inhibition of mevalonate pathway. Hepatol Res Off J Japan Soc Hepatol 39:479–489CrossRefGoogle Scholar
  20. 20.
    Seong J, Koom WS, Park HC (2005) Radiotherapy for painful bone metastases from hepatocellular carcinoma. Liver Int Off J Int Assoc Study Liver 25:261–265CrossRefGoogle Scholar
  21. 21.
    Habermehl D, Haase K, Rieken S et al (2011) Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: an analysis of survival and treatment efficacy. Tumori 97:609–613CrossRefGoogle Scholar
  22. 22.
    Chang SS, Luo JC, Chao Y et al (2001) The clinical features and prognostic factors of hepatocellular carcinoma patients with spinal metastasis. Eur J Gastroenterol Hepatol 13:1341–1345CrossRefGoogle Scholar
  23. 23.
    Nakamura N, Igaki H, Yamashita H et al (2007) A retrospective study of radiotherapy for spinal bone metastases from hepatocellular carcinoma (HCC). Jpn J Clin Oncol 37:38–43CrossRefGoogle Scholar
  24. 24.
    Kim CH, Chung CK, Jahng TA et al (2011) Surgical outcome of spinal hepatocellular carcinoma metastases. Neurosurgery 68:888–896CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNihon University School of MedicineTokyoJapan

Personalised recommendations