방사선의학 웹진

바로가기  >

Abstract

OBJECTIVE:

To establish a prognostic model for overall survival prediction in patients with hepatocellular carcinoma (HCC) treated with external beam radiotherapy (RT) for lymph node (LN) metastasis.

METHODS:

105 patients with HCC underwent RT for LN metastasis. The median age, biologically effective RT dose and follow-up period were 60 years, 59 Gy10 and 5.7 months, respectively. 51 patients had symptoms related to LN metastasis.

RESULTS:

The median survival (MS) was 5.8 months for all patients. For patients with LN-related symptoms, MS was 3.8 months compared with 10.7 months for those without LN-related symptoms. On multivariate analysis of pre-RT factors, symptoms related to LN metastasis [hazard ratio (HR) 2.93], Child-Pugh Class B-C (HR 2.77), uncontrolled intrahepatic disease (HR 2.74) and non-nodal distant metastasis (HR 1.62) were significantly poor prognostic factors for survival (all p < 0.05). Prognostic grouping into three groups by the number of risk factors also had a significant predictive value for survival, with patients having 0, 1, 2 and 3-4 risk factors demonstrating MS of 18.0, 11.7, 5.7 and 3.0 months, respectively (p < 0.001). A clinical nomogram based on the four prognostic factors was formulated and demonstrated good accuracy for predicting 6-month survival with a concordance index of 0.77.

CONCLUSION:

In a heterogeneous group of patients with HCC treated with RT for LN metastasis, the presence of LN-related symptoms was highly associated with poor survival. The prognostic grouping and nomogram developed by the present study can be effectively used for the prediction of survival.

ADVANCES IN KNOWLEDGE:

Patients treated with RT for LN metastases harbour various clinical features. Prognostic model and nomogram can help in predicting survival in these patients.​ 

Funded by the National Institute for Health Research; ProtecT Current Controlled Trials number, ISRCTN20141297 ; ClinicalTrials.gov number, NCT02044172 

ClinicalTrials.gov 

A service of the U.S. National Institutes of Health​

https://clinicaltrials.gov/show/NCT02044172 

Author information

Wee CW1, Kim K2, Chie EK1, Yu SJ3, Kim YJ3, Yoon JH3.​

11 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.

22 Department of Radiation Oncology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.

33 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.