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Clinical features and outcome of multiple primary malignancies involving hepatocellular carcinoma: A long-term follow-up study

Qing-An Zeng12, Jiliang Qiu1, Ruhai Zou1, Yijie Li12, Shengping Li1, Binkui Li1, Pinzhu Huang1, Jian Hong1, Yun Zheng1, Xiangming Lao1 and Yunfei Yuan1*

Author Affiliations

1 State Key Laboratory of Oncology in South China/Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, Guangdong, 510060, China

2 Department of General Surgery, the Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China

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BMC Cancer 2012, 12:148  doi:10.1186/1471-2407-12-148

Published: 17 April 2012



The prolonged survival of individuals diagnosed with cancer has led to an increase in the number of secondary primary malignancies. We undertook to perform a definitive study to characterize and predict prognosis of multiple primary malignancies (MPM) involving hepatocellular carcinoma (HCC), due to the scarcity of such reports.


Clinicopathological data were analyzed for 68 MPM patients involving HCC, with 35 (target group) underwent curative liver resection. Additional 140 HCC-alone patients with hepatectomy were selected randomly during the same period as the control group.


Of the 68 patients with extrahepatic primary malignancies (EHPM), 22 were diagnosed synchronously with HCC, and 46 metachronously. The most frequent EHPM was nasophargeal carcinoma, followed by colorectal and lung cancer. Univariate analysis demonstrated that synchronous (P = 0.008) and non-radical treatment for EHPM (P < 0.001) were significant risk factors associated with poorer overall survival (OS). While, Cox modeling revealed that the treatment modality for EHPM, but not the synchronous/metachronous determinant, was an independent factor for OS, and that therapeutic option for HCC was an independent factor for HCC-specific OS. Moreover, no HCC-specific overall and recurrence-free survival benefit were observed in the control group when compared with that of the target group (P = 0.607, P = 0.131, respectively).


Curative treatment is an independent predictive factor for OS and HCC-specific OS, and should been taken into account both for synchronous and metachronous patients. MPM patients involving HCC should not be excluded from radical resection for HCC.

Neoplasm; Multiple primary; Extrahepatic; Hepatocellular carcinoma; Prognosis