Abstract
ObjectiveTo explore the independent predictive factors of spontaneous tumor rupture (STR) in patients undergoing curative resection of hepatocellular carcinoma (HCC), and to evaluate the impact of STRHCC on long-term survival after hepatectomy.MethodsThe clinicopathological parameters of 106 patients with STRHCC and 201 patients with non-ruptured HCC who underwent hepatectomy from January 2007 to November 2011 at the Eastern Hepatobiliary Surgery Hospital and Zhongnan Hospital of Wuhan University were analyzed using propensity score matching (PSM) and a logistic regression model.ResultsFactors including hypertension, cirrhosis, total bilirubin (TB), tumor size, and ascites were independent predictors of STR. For all 307 HCC patients, the 1-, 3- and 5-year overall survival (OS) rates were 54.0%, 37.3% and 33.8%, respectively. After PSM, the 1-, 3-, and 5-year OS rates in the ruptured group remained significantly lower at 41.5%, 23.5%, and 17.5% when compared with the non-ruptured group at 70.8%, 47.1%, and 37.6%, respectively, while the 1-, 3-, and 5-year disease-free survival (DFS) rates between the groups did not differ significantly (50.4%, 35.1%, 27.1% vs 55.4%, 38.2%, 27.4%). STRHCC was significantly associated with increased risk of OS, but not of shorter DFS. No significant difference in postoperative morbidity or hospital death was observed between the groups.ConclusionFactors including hypertension, liver cirrhosis, higher TB levels, tumor size > 5cm, and ascites are significant predictors of STR. The recurrence rate of patients in the ruptured group was significantly higher than that of patients in the non-ruptured group. STR results in poorer OS but not DFS in patients undergoing curative resection for HCC. STRHCC has no impact on postoperative morbidity and mortality after hepatectomy.
Highlights
Hepatocellular carcinoma (HCC) is the fourth most commonly occurring cancer and the third commonest cause of cancerrelated deaths in China [1, 2]
Our study showed that Spontaneous tumor rupture of HCC (STRHCC) was more common in HCC patients with poorly preserved hepatic function, and especially young HCC patients with hepatitis B (HBV) infection and cirrhosis
These findings suggest heterogeneity of the patient population with STRHCC, and that the clinicopathological parameters associated with STRHCC differ among the subgroups
Summary
Hepatocellular carcinoma (HCC) is the fourth most commonly occurring cancer and the third commonest cause of cancerrelated deaths in China [1, 2]. Immediate intervention for hemostasis is the main treatment for STRHCC. Assessment should be carried out immediately when the bleeding has been arrested, which includes the overall condition of the patient, liver function, tumor stage, and resectability of the tumor (including the tumor location). Given that STRHCC is a contraindication to liver transplantation, hepatectomy remains the only potential curative intervention. The long-term survival rate of patients undergoing hepatectomy is superior to those undergoing other non-surgical treatments such as local ablative therapy, transhepatic artery embolization or chemoembolization [4]. Emergency or staged hepatectomy (embolization or other conservative procedures to achieve haemostasis, followed by surgery) is an effective treatment for STRHCC, and long-term survival can be achieved [2–5].
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