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Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma after liver transplantation

Jian He1, Zhao-Chong Zeng1*, Jia Fan2*, Jian Zhou2, Jing Sun1, Bing Chen1, Ping Yang1, Bin-Liang Wang1, Bo-Heng Zhang23 and Jian-Ying Zhang1

Author Affiliations

1 Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

2 Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China

3 Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai 200032, China

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BMC Cancer 2011, 11:492  doi:10.1186/1471-2407-11-492

Published: 22 November 2011



Little is known about the clinical features and prognostic factors of bone metastases of hepatocellular carcinoma (HCC) following liver transplantation (LT).


All adult patients undergoing LT from 2001 to 2010 were reviewed. Patients with HCC bone metastases after LT received external beam radiotherapy(EBRT) during this period. Demographic variables, laboratory values, and tumor characteristics were determined before LT and EBRT. Total radiation dose ranged from 8 to 60 Gy(median dose 40.0 Gy).


The trunk was the most common site of bone metastases with finding of expansile soft-tissue masses in 23.3% of patients. Overall pain relief from EBRT occurred in 96.7% (29/30). No consistent dose-response relationship was found for palliation of with doses between 30 and 56 Gy (P = 0.670). The median survivals from the time of bone metastases was 8.6 months. On univariate and multivariate analyses, better survival was significantly associated with a better Karnofsky performance status (KPS) and well-controlled intrahepatic tumor, but not with lower alpha-fetoprotein levels. The median time from LT to bone metastases was 7.1 months. Patients exceeding the Shanghai criteria presented with bone metastases earlier than those within the Fudan criteria. Patients with soft-tissue extension always had later bone metastases. The majority of deaths were caused by liver failure due to hepatic decompensation or tumor progression.


The prognostic factors of bone metastases of HCC following LT are KPS and well-controlled intrahepatic. Even though survival is shorter for these patients, EBRT provides effective palliation of pain.

Transplantation; Hepatocellular carcinoma; Bone metastases; Radiotherapy