Other primary neoplasms in patients with hepatocellular cancer: prognostic implications?

Purpose: Little is known about other primary neoplasms occurring in patients with hepatocellular cancer (HCC). This team attempted to characterize this cohort of patients to define incidence, risk factors, natural history, and potentially shared etiologies.

Methods: A retrospective analysis from an established, prospective database of patients with HCC during 1991-2004 was used to determine demographic data, risk factors, characteristics of the associated second primary neoplasm, and survival.

Main Findings: Of 306 patients with HCC, 23 patients (7.5%) were identified with a second neoplasm. Two of these patients had a third neoplasm. Mean age was 65.6 years and male:female ratio was 2.3:1. Risk factors included: hepatitis B (27.3%), hepatitis C (40.9%), smoking (17.4 %), diabetes (26.1%), cirrhosis (63.6%), and family history of HCC (4.5%). Second associated primaries included 7 genitourinary (prostate--2, bladder--2, testicular--1, renal--1, ovarian--1), 7 gastrointestinal (colon--6, gastric--1), 3 breast, 2 skin, 2 lung, 2 hematologic, 1 tongue, and 1 desmoid. Four patients had HCC first, 1 patient had synchronous HCC and colon cancer, while 18 had the other primary first. Mean, 1 and 2-year survival after diagnosis of HCC was 1014.8 days, 75%, and 30%, compared to 782.6 days, 54.6%, and 41.1%, respectively, in the group with HCC only (p > 0.05).

Conclusion: The incidence of other primary tumors in the setting of HCC is relatively common with a strong clustering of genitourinary and gastrointestinal malignancies. There was no statistically significant difference in overall survival compared to patients with HCC only, suggesting that the association of other primary tumors with HCC does not confer a worse prognosis.