Elevated lung shunt fraction as a prognostic indicator for disease progression and metastasis in hepatocellular carcinoma

Sandow, Tyler, De Vun, Daniel, Gulotta, Paul, Bohorquez, Humberto and Kirsch, David (2016) Elevated lung shunt fraction as a prognostic indicator for disease progression and metastasis in hepatocellular carcinoma. Journal of Vascular and Interventional Radiology, 27 6: 804-811. doi:10.1016/j.jvir.2016.01.129


Author Sandow, Tyler
De Vun, Daniel
Gulotta, Paul
Bohorquez, Humberto
Kirsch, David
Title Elevated lung shunt fraction as a prognostic indicator for disease progression and metastasis in hepatocellular carcinoma
Journal name Journal of Vascular and Interventional Radiology   Check publisher's open access policy
ISSN 1535-7732
1051-0443
Publication date 2016-06-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.jvir.2016.01.129
Open Access Status Not yet assessed
Volume 27
Issue 6
Start page 804
End page 811
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Collection year 2017
Language eng
Formatted abstract
Purpose: To evaluate lung shunt fraction (LSF) as an early predictor for local disease progression or the development of metastatic disease.

Materials and Methods: Retrospective analysis was performed on 52 patients with hepatocellular carcinoma who underwent preradioembolization assessment, including the calculation of LSF. Comparison of preprocedural and postprocedural surveillance imaging was performed. Mean patient age was 67 years (range, 50-88 y), with a mean surveillance of 245 days (range, 24-871 d). Statistical analysis was conducted to assess the relationship between LSF and local disease progression or development of new metastatic disease.

Results: In patients in whom metastatic disease developed during routine surveillance, the mean LSF was almost double that in patients in whom no metastasis developed (18.3% vs 9.3%; P =.001). Patients with elevated LSFs were also more likely to show intrahepatic disease progression (15.6% vs 8.5%; P =.003). LSFs < 8% corresponded to negative predictive values of 74% for local disease progression and 95% for development of metastasis, signaling a better prognosis. Of pretreatment variables examined (age, sex, previous treatment with disease progression, lesion size, lesion number, LSF, α-fetoprotein level, and portal vein thrombus), only LSF was an independent predictor for new metastasis (odds ratio [OR] = 1.2; P =.01). LSF (OR = 1.2; P =.03) and progression after previous treatment (OR = 4.7; P =.04) were independent predictors for local progression.

Conclusions: As local disease progression and metastatic disease were more likely to occur in patients with elevated LSFs, LSF may be the most sensitive predictor for local disease progression and new metastatic disease.
Keyword Lung shunt fraction (LSF)
Local disease progression
Metastatic disease development
Evaluation
Hepatocellular carcinoma (HCC)
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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