Harding JJ, et al. - Researchers here aimed at assessing the incidence, morbidity, and mortality related to bone metastases in hepatocellular carcinoma (HCC). Findings revealed that patients with AJCC stage IV HCC and bone metastases that are clinically evident on routine radiography or on clinical examination at presentation were prone to develop frequent, morbid, and mortal skeletal-related events (SREs), whereas those without evident bone metastasis at presentation were unlikely to develop these complications.

Methods

• Researchers searched the Memorial Sloan Kettering Cancer Center database for all patients with HCC and metastases seen from 2002 to 2014.
• They determined the prevalence of bone metastasis and used cumulative incidence function to assess the probability of developing a bone metastasis.  
• To identify risk factors for osseous metastasis, they created regression models.
• For this study, they determined the frequency of skeletal-related events [SREs: defined as pathologic fracture, spinal cord compression, need for radiation therapy to bone, and/or surgical resection of bone] and used cumulative incidence function to estimate the probability of SRE development.
• SRE risk factors were identified by creating regression models. Kaplan-Meier methodology was used to analyze the correlation of clinicopathologic parameters, including bone metastases and SREs, with overall survival.

Results

• Researchers identified a total of 459 patients with HCC and extrahepatic metastases.
• Bone metastases was present or developed in 151 patients (32.9%): 128 (27.9%) as a primary site and 23 (4.6%) as a secondary site of extrahepatic disease
• The yearly incidence of bone metastasis was 6.4% (95% CI, 3.6%–9.2%) among the 331 patients without bone metastasis at presentation.
• The risk of developing a bone metastasis increased with hepatitis B virus (HBV) infection (P=.02).
• At 6 months, the cumulative incidence of SREs was 50%.
• As per the univariate analysis, patients with HBV-related HCC showed a significantly higher incidence of SREs (P=.02).  
• In this study, sorafenib and bisphosphonates each was protective against SREs.
• The multivariable model demonstrated that the presence of SREs was independently associated with a worse overall survival (hazard ratio, 2.13; 95% CI, 1.52–2.97; P < .01).