• delayed cancer treatment
• extrahepatic metastases
• hepatocellular carcinoma
• oncologic ophthalmology
• orbital metastasis

• Alternative splicing
• Hepatocellular carcinoma
• HnRNPR
• Invasion and metastasis
• UPF3B-S

• Humans
• Carcinoma, Hepatocellular/genetics
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/metabolism
• Liver Neoplasms/genetics
• Liver Neoplasms/pathology
• Liver Neoplasms/metabolism
• Animals
• Mice
• Gene Expression Regulation, Neoplastic
• Cell Line, Tumor
• Alternative Splicing/genetics
• Neoplasm Metastasis
• Male
• RNA, Messenger/genetics
• RNA, Messenger/metabolism
• Cadherins/genetics
• Cadherins/metabolism
• Epithelial-Mesenchymal Transition/genetics
• RNA-Binding Proteins/genetics
• RNA-Binding Proteins/metabolism
• Cell Movement/genetics
• Mice, Nude
• Antigens, CD

• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Carcinoma, Hepatocellular/secondary
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/diagnostic imaging
• Male
• Maxillary Neoplasms/pathology
• Maxillary Neoplasms/diagnostic imaging
• Pharyngeal Neoplasms/pathology
• Pharyngeal Neoplasms/diagnostic imaging
• Pharyngeal Neoplasms/secondary
• Tomography, X-Ray Computed
• Middle Aged

• hepatocellular carcinoma
• maxillary sinus mass
• metastasis
• recurrence
• solitary

• 1,25(OH)2D3
• Hepatocellular carcinoma
• MAPK/ERK signaling
• hCAP18/LL-37
• metastasis

• Abdominal disorders
• Anatomy and pathology
• Computed tomography
• Magnetic resonance imaging
• Properitoneal fat pad
• Radiological diagnosis

• Humans
• Magnetic Resonance Imaging/methods
• Fascia
• Abdominal Wall
• Adipose Tissue/diagnostic imaging
• Adipose Tissue/pathology
• Tomography, X-Ray Computed

• bronchoscopy
• endobronchial
• hepatocellular carcinoma
• metastases
• pathology

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide. This study aims to construct a novel practical nomogram and risk stratification system to predict cancer-specific survival (CSS) in HCC patients with severe liver fibrosis.

Data on 1,878 HCC patients with severe liver fibrosis in the period 1975 to 2017 were extracted from the Surveillance, Epidemiology, and End Results database (SEER). Patients were block-randomized (1,316 training cohort, 562 validation cohort) by setting random seed. Univariate and multivariate COX regression analyses were employed to select variables for the nomogram. The consistency index (C-index), the area under time-dependent receiver operating characteristic curve (time-dependent AUC), and calibration curves were used to evaluate the performance of the nomogram. Decision curve analysis (DCA), the C-index, the net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to compare the nomogram with the AJCC tumor staging system. We also compared the risk stratification of the nomogram with the American Joint Committee on Cancer (AJCC) staging system.

Seven variables were selected to establish the nomogram. The C-index (training cohort: 0.781, 95%CI: 0.767–0.793; validation cohort: 0.793, 95%CI = 95%CI: 0.779–0.798) and the time-dependent AUCs (the training cohort: the values of 1-, 3-, and 5 years were 0.845, 0.835, and 0.842, respectively; the validation cohort: the values of 1-, 3-, and 5 years were 0.861, 0.870, and 0.876, respectively) showed satisfactory discrimination. The calibration plots also revealed that the nomogram was consistent with the actual observations. NRI (training cohort: 1-, 2-, and 3-year CSS: 0.42, 0.61, and 0.67; validation cohort: 1-, 2-, and 3-year CSS: 0.26, 0.52, and 0.72) and IDI (training cohort: 1-, 3-, and 5-year CSS:0.16, 0.20, and 0.22; validation cohort: 1-, 3-, and 5-year CSS: 0.17, 0.26, and 0.30) indicated that the established nomogram significantly outperformed the AJCC staging system (P < 0.001). Moreover, DCA also showed that the nomogram was more practical and had better recognition.

A nomogram for predicting CSS for HCC patients with severe liver fibrosis was established and validated, which provided a new system of risk stratification as a practical tool for individualized treatment and management.

Hepatocellular carcinoma (HCC) is a primary liver cancer with high prevalence and mortality. There are many cases of advanced HCC at the time of diagnosis. Treatment methods and prognosis are different depends on whether metastasis is present. Thus, it is necessary to make an accurate evaluation at the time of diagnosis. Extrahepatic metastases of HCC usually occur through hematogenous spread or through adjacent organs such as the peritoneum. Metastasis to the urinary bladder alone is rare. Here, we report a rare case of biopsy-proven solitary metastasis of HCC to the bladder in a 60-year-old woman.

A 60-year-old female patient was found to be positive for hepatitis B surface antigen by chance after abdominal ultrasonography showed abnormal findings. Thus, liver dynamic computed tomography (CT) was performed. The patient visited the hospital for further examination. Ultrasound and CT showed 3.6 cm sized arterial enhancing mass in segment 5 and an infiltrative mass in segment 8. The patient was diagnosed with HCC through liver dynamic magnetic resonance imaging and liver biopsy. Afterwards, she underwent two transcatheter arterial chemoembolizations within five months for HCC. During follow-up, a newly appeared bladder tumor was found on liver dynamic CT. She underwent transurethral resection of the bladder tumor for diagnosis and treatment. The tissue was confirmed as metastatic HCC.

Although rare, metastasis to urinary bladder from HCC can occur without evidence of other distant metastases. Thus, regular follow-up imaging examination and clinical attention are required.

• Hepatocellular carcinoma
• Metastasis
• Urinary bladder
• Case report