Exploring the role of locoregional treatment in hepatocellular carcinoma patients with different patterns of extrahepatic metastases

Background Hepatocellular carcinoma (HCC) patients with extrahepatic metastasis (EM) constitute a heterogeneous group with dismal survival even after systemic treatments. We aimed to evaluate the survival benefit of local treatment (LA) regarding the extent of EMs. Methods We retrospectively identified 1,994 HCC patients with EMs from Surveillance, Epidemiology, and End Results database from 2010 to 2015, who were divided into the single- and multi-EM subgroups. The overall survival (OS) was compared among different treatment modalities with the Kaplan-Meier method in each subgroup. Cox regression analysis was used to explore independent prognostic factors. Results The treatment modalities were classified into no treatment, chemotherapy alone, LA alone and the combination of chemotherapy and LA. Both the treatment modalities and locoregional treatment for hepatic lesions were independent factors for the OS of HCC patients with EMs. The combination of chemotherapy and LA achieved better OS than chemotherapy or LA alone in either single-EM or multi-EM group (P < 0.001). Besides, chemotherapy or LA alone did not significantly improve the OS compared with no treatments in the multi-EM group. As for local ablative treatments for hepatic lesions, only HCC patients with single EM and single intrahepatic lesion could benefit from it. Conclusions The combination of systemic and locoregional treatments could improve the survival outcome of metastatic HCC patients, either with single or multiple EMs. Locoregional treatment for primary hepatic lesions might be suitable only for HCC patients with limited intra- and extrahepatic tumor burden.