Value of Follow-Up Chest Computed Tomography in the Surveillance of Patients with Hepatocellular Carcinoma

RESULTS

Patient Demographics

Our initial search of the institutional database identified 736 HCC patients. Of these 736 patients, 486 were excluded because they did not undergo chest CT at or within three days of the abdominal examination; 19 were excluded because they had multiple primary malignancies; and five were excluded because they underwent follow-up CT less than 6 weeks after baseline CT. Thus, the study included 226 patients (37 women and 189 men) (Figure 1). The mean age was 65 years (standard deviation, 9 years).

Radiology Results

Baseline Studies

Baseline CT revealed that 36 patients (16%) had metastatic disease in the chest, 40 (17.7%) had extrahepatic metastatic disease, and 193 (85%) had disease burden in the liver (Table 1). Seventy-six patients had extrahepatic disease in the chest or abdomen (33.6%).

Follow-Up Studies

Follow-up CT revealed that 38 (17%) patients had disease progression in the chest, 92 (41%) had disease progression in the liver (Table 2), and 49 (22%) had extrahepatic disease progression in the abdomen (Table 3). Forty-six (20.4%) and eighty-eight (38.9%) had improved or stable disease in the liver, respectively. Fourteen patients had improved extrahepatic disease in the abdomen and 163 had stable extrahepatic disease in the abdomen. The mean time to follow-up CT was 22 weeks (range, 6 −110 weeks).

Follow-up CT also revealed that of the 38 patients who had progression in the chest, 25 also had progression in the liver (Table 2), 16 also had extrahepatic progression in the abdomen (Table 3), and 31 had extrahepatic or hepatic progression in the abdomen (Table 4). Only seven patients had progression in the chest without disease progression below the diaphragm. Of the 38 patients who had progression in the chest on follow-up CT, 16 had metastatic disease in the chest at baseline CT. Of these 16 patients, 15 also had progression in either the liver or abdomen on follow-up CT (Tables 2–4).

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Twenty-two patients had progression in the chest on follow-up CT with no metastatic disease in the chest at baseline CT. Of 22 patients who had a negative baseline CT, 5 had progression in the chest with a negative baseline CT and without corresponding progression of disease in the liver or abdomen on follow-up CT (2.2%; 5/226).

In summary, 7 patients (3.1%; 7/226) had progression in the chest without corresponding progression in the liver or abdomen on follow-up CT.

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