Survival outcome of operated spontaneous ruptured hepatocellular carcinoma – A propensity score matching analysis

Abstract

Introduction: Patients presented with ruptured hepatocellular carcinoma (rHCC) were staged as T4 disease in 7th edition TNM staging. However, studies suggested contradictory results including poorer outcome or non-inferiority overall survival in patients who were operated. This study aimed to identify the outcome of patients presented with rHCC and compared with the current TMN staging. Methods: A retrospective review of patients with rHCC who were able to undergo interval hepatectomy from 1989 to 2015 was performed. The perioeperative details, clinical course, pathological data and survival outcome were studied. Propensity score matching analysis was performed for tumor size and number in 1:3 for those without ruptured. The Kaplan-Meier method was used for survival analysis and log-rank test was used for survival comparison. Results: There were total 115 patients who had rHCC underwent hepatectomy. 345 patients without tumor ruptured were matched for comparison. Patients in rHCC had more Child B cirrhosis (11.3% vs 4.3%, p=0.007). The postoperative outcome including complication rate and hospital stay were similar. The tumor pathology was similar in both groups, so as the disease recurrent pattern. However rHCC patients had earlier disease recurrence and poorer overall survival (5-years 26.5% vs 45.2%, p=0.006). Further analysis on TMN staging suggested that rHCC patients did better than stage IIIB patients (5-year 26.5% vs 18.9%, 0.008), suggesting T4 stage IIIC for rHCC may not be the correct prediction. Conclusions: RHCC patients had inferior overall survival as compared to those patients without ruptured. These patients may not fit into T4 stage IIIC TMN staging.