Survival and prognostic analysis of ruptured hepatocellular carcinoma patients with subclinical bleeding after elective hepatectomy

Abstract

Objective To discuss the prognosis of ruptured hepatocellular carcinoma (HCC) patients with subclinical bleeding after elective hepatectomy. Methods Clinical data of 614 patients with HCC who underwent elective hepatectomy in Department of Hepatobiliary Surgery, the Affiliated Hospital of Medical College, Qingdao University from January 1997 to December 2010 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. According to whether the patients had subclinical bleeding following ruptured HCC or not, they were devided into ruptured group (n=30; 25 males, 5 females; 29 to 73 of age, 55 of median age) and non-ruptured group (n=584; 488 males, 96 females; 14 to 82 of age, 55 of median age). All the patients underwent hepatectomy. Clinical characters of patients in ruptured group and non-ruptured group were observed. All the patients received follow-up after operations, the survival and causes of death were observed. The Kaplan-Meier survival curves were drawn according to the results of follow-up, and the survival of 2 groups was compared. The relation between the clinical parameters and the prognosis of patients in ruptured group was analyzed. The clinical parameters in 2 groups were compared using Chi-square test or Fisher’s exact probability method. Multiple factors analysis between groups was conducted using Logistic regression analysis. Survival analysis and comparison were conducted using Kaplan-Meier method and Log-rank test. Prognostic risk factor analysis was conducted using Cox proportional hazards regression model analysis. Results The patients with non-radical resection, liver resection range > 1 segment, surgical margin 5 cm and poorly differentiated tumor in ruptured group were significantly more than those in non-ruptured group (χ2=37.609, 6.021, 6.497, 20.982, 19.498, 22.944, 8.222; P 5 cm were the independent risk factors for ruptured HCC with subclinical bleeding (OR=3.772, 5.045; P<0.05). There were 26 deaths in ruptured group and 316 deaths in non-ruptured group during the follow-up. Kaplan-Meier analysis showed that the median survival time was 9 months in ruptured group and 56 months in non-ruptured group. The 1-, 3-, 5-year accumulative survival rate were 50.0%, 22.2%, 5.9% in ruptured group and 86.0%, 62.6%, 48.9% in non-ruptured group respectively, where significant difference was observed (χ2=38.879, P<0.05). Cox proportional hazards regression model analysis showed that poorly differentiated tumor was an independent risk factor for patients in ruptured group after hepatectomy (RR=3.736, P<0.05). Conclusions Non-radical resection and tumor diameter > 5 cm are the independent risk factors for ruptured HCC with subclinical bleeding. The prognosis of ruptured HCC patients with subclinical bleeding after elective hepatectomy is still poor, and poorly differentiated tumor is an independent risk factor for it. Key words: Carcinoma, hepatocellular; Rupture; Hepatectomy; Survival rate; Prognosis