“Factors such as tumor grade, cancer-directed treatment, age, facility type, and even race significantly impact the overall survival (OS) of patients with hepatocellular carcinoma (HCC) with bone metastasis,” Ilyas Sahin, MD, explains. “These insights could reshape treatment decisions and improve outcomes for this challenging patient population.”

Bone metastases in HCC are relatively rare, but their impact on prognosis is well known, he notes. “However, the comprehensive exploration of various factors influencing survival provides a nuanced understanding that can guide clinical decisions in an increasingly personalized manner.”

OS Linked With Clinical & Tumor Traits

Dr. Sahin and colleagues analyzed 2010-2019 National Cancer Database data from 5,285 adults with HCC and bone metastasis. Of these, 86.2% were male, 61.2% were non-Hispanic White, 89% had a total Charlson-Deyo comorbidity score less than 3, and 41.4% were treated in academic facilities. Regarding age, 3.8% were younger than 50, 51.3% were 50-64, and 44.9% were 65 or older.

Of the 952 patients with known tumor grade, 24.8% had grade I, 39.1% had grade II, and 36.1% had grade III. Chemotherapy was administered to 39.5% of patients.

As reported in the Journal of Hepatocellular Carcinoma, the researchers included comorbidity scores, treatment characteristics, and demographics in Kaplan–Meier analyses to calculate median lengths of OS.

In univariate survival analyses, patients with well-differentiated (grade I) tumors had significantly better OS than those with poorly differentiated (grade III) tumors (5.4 vs 3.0 months; P=0.001).

Patients on single- or multiagent first-course chemotherapy had significantly improved OS compared with those not receiving chemotherapy (7.0, 8.5, and 1.94 months, respectively; P<0.001).

Median OS decreased with increasing age: 5.0 months for patients under 50 years, 3.8 months for patients 50-64, and 3.4 months for patients 65 or older (P<0.001; Figure).

Non-Hispanic White patients had lower median survival time than non-Hispanic Black and Hispanic patients (3.4, 4.0, and 4.0 months, respectively; P<0.001).

Patients with a total Charlson-Deyo score of 0 survived longer than those with a total score of 3 (4.1 vs 2.1 months; P<0.001).

Patients treated at academic facilities survived longer than those treated at non-academic facilities (4.3 vs 3.2 months; P<0.001). No significant differences in survival based on sex were found.

Personalized Care “Greatly Affects” Survival

Prioritizing well-differentiated tumors and considering factors such as age and facility type can impact outcomes, Dr. Sahin says. “For instance, the fact that patients with HCC and bone metastasis who received single- or multiagent treatments showed significantly extended survival compared with those without therapy underscores how personalized choices, including HCC treatment, can greatly affect their survival.”

Dr. Sahin is interested in further research to explore the impact of specific treatment regimens, demographic factors, and underlying mechanisms that affect patient survival.

“Importantly, immunotherapy, a novel HCC treatment, was not covered due to its newness; however, its potential role is worth monitoring, and it is essential to await new data encompassing immunotherapy patients,” he advises.

“Investigating long-term effects beyond survival, considering emerging therapies, and engaging in collaborative multicenter studies can provide deeper insights for tailored treatment strategies that can refine patient care in this evolving landscape,” Dr. Sahin adds.