A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes

Leonardo Da Fonseca; Paulo Leonardi; Pedro Hashizume; Francesco Sansone; Lisa Saud; Flair Carrilho; Paulo Herman

doi:10.5114/ceh.2022.114297

eISSN: 2449-8238
ISSN: 2392-1099

Clinical and Experimental Hepatology

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abstract:

Original paper

A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes

Leonardo G. Da Fonseca

^{1, 2}

,

Paulo C. Leonardi

¹

,

Pedro H. Hashizume

¹

,

Francesco Sansone

¹

,

Lisa R. Saud

^{2, 3}

,

Flair J. Carrilho

^{2, 3}

,

Paulo Herman

^{2, 4}

Instituto do Cancer do Estado de São Paulo, University of São Paulo, Brazil
Sao Paulo Clinicas Liver Cancer Group, Brazil
Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Brazil
Department of Gastroenterology, Hospital das Clinicas University of São Paulo School of Medicine, Brazil

Clin Exp HEPATOL 2022; 8, 1: 42-48

DOI: https://doi.org/10.5114/ceh.2022.114297

Online publish date: 2022/03/23

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AMA

Da Fonseca LG, Leonardi PC, Hashizume PH, et al. A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes. Clinical and Experimental Hepatology. 2022;8(1):42-48. doi:10.5114/ceh.2022.114297.

APA

Da Fonseca, L. G., Leonardi, P. C., Hashizume, P. H., Sansone, F., Saud, L. R.,  & Carrilho, F. J. et al. (2022). A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes. Clinical and Experimental Hepatology, 8(1), 42-48. https://doi.org/10.5114/ceh.2022.114297

Chicago

Da Fonseca, Leonardo G, Paulo C Leonardi, Pedro H Hashizume, Francesco Sansone, Lisa R Saud, Flair J Carrilho,  and Paulo Herman. 2022. "A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes". Clinical and Experimental Hepatology 8 (1): 42-48. doi:10.5114/ceh.2022.114297.

Harvard

Da Fonseca, L., Leonardi, P., Hashizume, P., Sansone, F., Saud, L., Carrilho, F.,  and Herman, P. (2022). A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes. Clinical and Experimental Hepatology, 8(1), pp.42-48. https://doi.org/10.5114/ceh.2022.114297

MLA

Da Fonseca, Leonardo et al. "A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes." Clinical and Experimental Hepatology, vol. 8, no. 1, 2022, pp. 42-48. doi:10.5114/ceh.2022.114297.

Vancouver

Da Fonseca L, Leonardi P, Hashizume P, Sansone F, Saud L, Carrilho F et al. A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes. Clinical and Experimental Hepatology. 2022;8(1):42-48. doi:10.5114/ceh.2022.114297.

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Aim of the study
Hepatocellular carcinoma (HCC) is a lethal malignancy with heterogeneous behavior determined by liver function, clinical presentation and treatment response. Peritoneal metastasis (PM) from HCC is rare and management is challenging. We aim to report a cohort of patients with advanced HCC and describe demographic characteristics, treatment and outcomes of patients with PM.

Material and methods
We analyzed data from a retrospective cohort of patients with HCC. Patients with PM were analyzed individually. Baseline characteristics, treatment strategy and median overall survival (OS) with 95% confidence interval (CI) were reported.

Results
238 patients with advanced HCC were evaluated. Eleven patients had PM: 7 patients were treated with systemic treatment and 4 were treated with upfront peritonectomy followed by systemic treatment at recurrence. These 4 patients had well-preserved liver function and low disease burden and were younger compared to the total cohort. The median time to recurrence after peritonectomy was 30.25 months (interquartile range [IQR]: 13.53-46.92): 3 of them presented peritoneal recurrence (2 with diffuse peritoneal spread and 1 with concomitant hepatic recurrence) and 1 presented pulmonary recurrence. Overall, patients with PM showed similar OS compared to patients with other metastatic sites (11.8 months; 95% CI: 1.5-19.8 vs. 8 months; 95% CI: 6.7-10, p = 0.901). Patients with PM treated with upfront surgery had a median OS of 60 months (95% CI: 16.7-not reached).

Conclusions
Resection of PM from HCC may provide long-term survival in selected patients. A multidisciplinary approach is the optimal strategy for managing PM from HCC.

keywords:

A multidisciplinary approach to peritoneal metastasis from hepatocellular carcinoma: clinical features, management and outcomes

Leonardo G. Da Fonseca 1, 2 , Paulo C. Leonardi 1 , Pedro H. Hashizume 1 , Francesco Sansone 1 , Lisa R. Saud 2, 3 , Flair J. Carrilho 2, 3 , Paulo Herman 2, 4

hepatocellular carcinoma, peritonectomy, liver cancer, prognosis, cancer treatment

Leonardo G. Da Fonseca

^{1, 2}

,

Paulo C. Leonardi

¹

,

Pedro H. Hashizume

¹

,

Francesco Sansone

¹

,

Lisa R. Saud

^{2, 3}

,

Flair J. Carrilho

^{2, 3}

,

Paulo Herman

^{2, 4}