Spontaneous Rupture Of Hepatocellular Carcinoma Research Articles

Treatment and prognosis study of spontaneous rupture hemorrhage in hepatocellular carcinoma: Recommendations for adding the A1 stage to the BCLC staging system.

The Barcelona Clinic Liver Cancer (BCLC) staging system is an internationally recognized clinical staging system for hepatocellular carcinoma (HCC). However, this staging system does not address the staging and surgical treatment strategies for patients with spontaneous rupture hemorrhage in HCC. In this study, we aimed to investigate the prognosis of patients with BCLC stage A undergoing liver resection for HCC with spontaneous rupture hemorrhage and compare it with the prognosis of patients with BCLC stage A undergoing liver resection without rupture. Clinical data of 99 patients with HCC who underwent curative liver resection surgery were rigorously followed up and treated at Shandong Provincial Hospital from January 2013 to January 2023. A retrospective cohort study design was used to determine whether the presence of ruptured HCC (rHCC) is a risk factor for recurrence and survival after curative liver resection for HCC. Prognostic comparisons were made between patients with ruptured and non-ruptured BCLC stage A HCC (rHCC and nrHCC, respectively) who underwent curative liver resection. rHCC (hazard ratio [HR] = 2.974, [p] = 0.016) and tumor diameter greater than 5 cm (HR = 2.819, p = 0.022) were identified as independent risk factors for overall survival (OS) after curative resection of BCLC stage A HCC. The postoperative OS of the spontaneous rupture in the HCC group (Group I) was shorter than that in the BCLC stage A group (Group II) (p = 0.008). Tumor invasion without penetration of the capsule was determined to be an independent risk factor for recurrence-free survival (RFS) after liver resection for HCC (HR = 2.584, p = 0.002). HCC with concurrent spontaneous rupture hemorrhage is an independent risk factor for postoperative OS after liver resection. TheBCLC stage A1 should be added to complement the current BCLC staging system to provide further guidance for the treatment of patients with spontaneous rupture of HCC.

Clonorchis sinensis on the prognosis of patients with spontaneous rupture of Hepatocellular Carcinoma: An inverse probability of treatment weighting analysis.

We examined the impact of the Clonorchis sinensis (C. sinensis) infection on the survival outcomes of spontaneous rupture Hepatocellular Carcinoma (srHCC) patients undergoing hepatectomy. Between May 2013 and December 2021, 157 consecutive srHCC patients who underwent hepatectomy were divided into an no C. sinensis group (n = 126) and C. sinensis group (n = 31). To adjust for differences in preoperative characteristics an inverse probability of treatment weighting (IPTW) analysis was done, using propensity scores. Overall survival (OS) and recurrence-free survival (RFS) were compared before and after IPTW. Multivariate Cox regression analysis was performed to determine whether the C. sinensis infection was an independent prognostic factor after IPTW. In original cohort, the no C. sinensis group did not show a survival advantage over the C. sinensis group. After IPTW adjustment, the median OS for the C. sinensis group was 9 months, compared to 29 months for the no C. sinensis group. C. sinensis group have worse OS than no C. sinensis group (p = 0.024), while it did not differ in RFS(p = 0.065). The multivariate Cox regression analysis showed that C. sinensis infection and lower age were associated with worse OS. The C. sinensis infection has an adverse impact on os in srHCC patients who underwent hepatectomy.

Spontaneously Ruptured Hepatocellular Carcinoma Treated by Transarterial Embolization Compared with Conservative Treatment: Survival Outcome and Prognostic Factors

Objective: To report the survival outcome and prognostic factors in the patients with spontaneously ruptured hepatocellular carcinoma treated by transarterial embolization compared with conservative treatment. Materials and Methods: A retrospective review of 89 patients who had spontaneous rupture of hepatocellular carcinoma (HCC) at Siriraj Hospital between January 2011 and February 2017 were enrolled. Ruptured HCC patients are diagnosed by clinical presentations of abdominal pain/distension, anemia/shock with dynamic liver computed tomography findings as: hemoperitoneum, focal discontinuity or tumor protrusion of the hepatic surface and/or active contrast material extravasation. We compared the survival outcome and prognostic factors of the ruptured HCC patients who received two treatment methods; conservative treatment and transarterial embolization (TAE). Results: The cumulative median survival time of the ruptured HCC patients was significantly higher in the TAE group (81 days) than in the conservative treatment group (29 days) with p-value = 0.006. There were two significant predictors for post-treatment mortality. First, treatment modality in the TAE group showed a significantly lower mortality rate than in the conservative treatment group with a hazard ratio (HR) 0.454 (p-value = 0.003). Second, a pre-treatment high hematocrit level was a significant predictive factor for lower mortality than a low hematocrit level with a hazard ratio (HR) 0.946 (p-value = 0.016). Conclusion: TAE results in a good clinical outcome and increased survival rate in the patients with ruptured HCC. A pre-treatment high hematocrit level was a good prognostic factor for the survival in ruptured HCC patients.

Dropping of follow-up, succeded by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: a case report and review of literature

Dropping of follow-up, succeded by emergency surgery for a second spontaneous rupture of hepatocellular carcinoma: a case report and review of literature

Spontaneous Rupture of Hepatocellular Carcinoma With Fatal Outcome in a Patient Taking Direct-Acting Antivirals

Spontaneous Rupture of Hepatocellular Carcinoma With Fatal Outcome in a Patient Taking Direct-Acting Antivirals

Is transarterial embolization plus two-stage hepatectomy the optimal strategy for the treatment of spontaneous rupture of hepatocellular carcinoma?

Is transarterial embolization plus two-stage hepatectomy the optimal strategy for the treatment of spontaneous rupture of hepatocellular carcinoma?

Revision and addendum to the manuscript titled "Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma".

Revision and addendum to the manuscript titled "Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma".

Robotic emergency liver resection of ruptured hepatocellular carcinoma.

The spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the possibility of the best curative treatment. We report our experience of an emergency robotic liver resection for a ruptured HCC in an elderly patient. Minimally invasive liver resection is currently recognised as a safe and feasible approach to the treatment of HCC in elderly patients. Our patient presented haemodynamic stability, which allows us to perform a robotic resection of segment 3. To our knowledge, this is the first report of the application of a robotic platform in an emergency setting for liver resection. Rupture of HCC is an uncommon complication, burdened by a high rate of mortality. Its management still remains controversial. Treatment should be individualised taking into consideration the clinical status of the patient, tumour features and possibility of centre therapeutic strategy.

Prognosis of spontaneously ruptured hepatocellular carcinoma: a propensity score matching study.

Spontaneous rupture is a fatal complication of hepatocellular carcinoma (HCC). This study compared the prognosis of spontaneously ruptured HCC (srHCC) with that of non-ruptured HCC (nrHCC). A total of 185 srHCC patients and 1085 nrHCC patients treated by hepatectomy between February 2005 and December 2017 at Zhongshan Hospital were retrospectively reviewed and enrolled. The overall survival (OS) and time to recurrence (TTR) were evaluated. A 1:2 propensity score matching (PSM) analysis was performed using the nearest neighbor matching with a caliper of 0.2. Before PSM, patients with srHCC who underwent hepatectomy (n = 185) had a poorer prognosis than those with nrHCC (n = 1085; 5-year OS, 39.1% vs 59.2%, P < 0.001; 5-year TTR, 83.8% vs 54.9%, P < 0.001). After PSM, patients with srHCC (n = 156) had higher 5-year TTR (83.2% vs 69.0%, P < 0.001) but comparable 5-year OS with those with nrHCC (n = 312, 44.0% vs 46.0%, P = 0.600). Univariate and multivariate analyses demonstrated spontaneous rupture as an independent risk factor for TTR (hazard ratio [HR], 1.681; 95% confidence interval [CI] 1.326-2.132; P < 0.001), but not for OS (HR: 1.074; 95% CI 0.823-1.401; P = 0.600). Further analysis revealed that srHCC was not appropriate to be assigned as T4 stage in American Joint Committee on Cancer classification. Spontaneous rupture of HCC is not a risk factor for survival. If resected eventually, srHCC may achieve comparable survival with nrHCC.

Early Mortality After Emergency Transarterial Embolization/Chemoembolization for Spontaneous Rupture of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

Context: Transarterial embolization/chemoembolization (TAE/TACE) has been shown to be effective against ruptured hepatocellular carcinoma (HCC). However, the early clinical mortality remains unpredictable. Objectives: To conduct a comprehensive quantitative evaluation of early mortality after emergency TAE/TACE for spontaneous HCC rupture and to perform an overall analysis of risk factors to gather more representative data. Methods: The PubMed/Medline, Web of Science, and Embase databases were searched, and relevant studies were retrieved using the corresponding English keywords. Next, the literature was screened according to the inclusion and exclusion criteria. Finally, Stata version 15.1 and R Project 4.1.2 were used for meta-analysis. Results: A total of 24 studies (n = 1,083) were included in this meta-analysis. The combined 30-day mortality following emergency TAE/TACE for spontaneous HCC rupture was 28.8% (95% confidence interval [CI]: 23.4 - 34.4%). After correcting for publication bias, the combined 30-day mortality rate was estimated at 28.1% (95% CI: 22.7 - 33.6%). The results of subgroup and regression analyses also revealed that preoperative liver cirrhosis and bilobar tumor distribution were significantly associated with increased 30-day mortality following TAE/TACE (P &lt; 0.05 for all). After re-stratification of studies by publication time, it was found that the 30-day mortality after TAE/TACE treatment for spontaneous HCC rupture has decreased significantly in the past two years (P = 0.0074); the corresponding value was 19.1% (95% CI: 14.3 - 24.3%) during 2020 - 2021 and 31.6% (95% CI: 26.4 - 36.9%) during 2001 - 2010. Three independent factors, including liver cirrhosis, bilobar tumor distribution, and period of time, may be potential factors for heterogeneity. Conclusion: In recent years, although early mortality has significantly reduced after emergency TAE/TACE for spontaneous HCC rupture, it is still not negligible. Before TAE/TACE, it is necessary for clinicians to predict the adverse outcomes, as well as the risk factors and disease-related factors, and to formulate appropriate intervention measures.

Spontaneous Rupture of Hepatocellular Carcinoma with Hemorrhagic Shock

Spontaneous Rupture of Hepatocellular Carcinoma with Hemorrhagic Shock

Complete Pathological Response in Advanced Hepatocellular Carcinoma. Peek-A-Boo?

Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially lethal complication. Despite various treatment modalities with curative intent, there are scant data on ruptured cases achieving complete pathological response (pCR), with only a handful of case reports. We report a case of a Chinese male patient with large advanced HCC (aHCC) first detected with rupture in an emergency setting, developing a pCR after multidisciplinary onco-surgical approach.

Propensity score matching study of 325 patients with spontaneous rupture of hepatocellular carcinoma.

This study aims to find out the possible optimal therapy and assess the prognosis properly for patient with spontaneous rupture of hepatocellular carcinoma (HCC). Propensity score matching (PSM) analysis was used to study the data from 325 patients with ruptured HCC (RHCC) and 2,291 patients with non-RHCC. The incidence and hospital mortality of RHCC were 5.1% and 0.8% respectively, with a median overall survival (OS) time of 17 months. There was no difference between ruptured and non-RHCC patients undergoing conservation treatment in terms of OS. Trans-arterial embolization (TAE) was carried out in 69 (21.2%) cases with RHCC, with a median OS of 7 months, which was no difference from that of non-RHCC (pre- and post-PSM). One hundred and sixty-nine (52.0%) RHCC cases underwent one-stage hepatectomy, with a median OS and disease-free survival (DFS) of 30 and 6 months respectively, which were shorter than that of non-RHCC (post-PSM). TAE plus two-stage hepatectomy was performed in 30 RHCC cases, with a median OS and DFS of 28 and 10 months respectively; these outcomes were better than that from RHCC patients undergoing TAE alone or one-stage hepatectomy (post-PSM), which were no difference from that of non-RHCC patients undergoing hepatectomy. The risk of death for RHCC patient undergoing one-stage hepatectomy is 1.545 times higher than that of one undergoing TAE + two-stage hepatectomy. TAE plus two-stage hepatectomy might be the optimal treatment for RHCC patient. Under the premise of the same pathological properties, there is no difference in prognosis between ruptured and non-RHCC patients if the therapy is appropriate.

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

Clinical course and role of embolization in patients with spontaneous rupture of hepatocellular carcinoma.

BackgroundA diverse clinical course after the spontaneous rupture of hepatocellular carcinoma (HCC) renders nonstandardized treatment protocols.PurposeTo evaluate clinical course and role of transcatheter arterial embolization (TAE) in patients with rupture of HCC.Materials and methodsThis retrospective study included 127 patients who were treated for ruptured HCC at single institution between 2005 and 2014. After multidisciplinary discussion, patients underwent medical management, TAE, emergency surgery or staged surgery. Patients were retrospectively divided into two groups based on the intent of treatment: curative and palliative. The rebleeding rate and 1-month and overall survival (OS) were compared between two groups. The incidence and survival of patients with intraperitoneal drop metastasis (IPDM) were also analyzed.ResultsThe overall rebleeding rate in patients who underwent TAE was 3.1% (3/96). One-month mortality rate was 6.3% (8/127). The rebleeding and 1-month mortality rates were not significantly different between two groups. OS was significantly higher in the curative treatment group (median: 12.0 vs 2.2 months, p<0.001). Among 96 patients who initially received TAE, ten patients underwent staged operation (10.4%). The median OS for medical management, TAE, emergency surgery and staged surgery was 2.8, 8.7, 19.1 and 71.1 months, respectively. Of all patients, 15.2% developed IPDM mostly within 1 year and their survival was poorer than that of patients without IPDM (median: 6.3 vs. 15.1 months, p<0.001).ConclusionTAE provided effective immediate hemostasis with a low rebleeding rate and may serve as a bridge to elective surgery. IPDM frequently occurred within 1 year and manifested poor survival; thus, close surveillance should be considered for patients with spontaneous rupture of HCC.

Emergency open drainage of massive hemoperitoneum and early stage left hepatectomy for abdominal compartment syndrome due to hepatocellular carcinoma rupture: a case report

BackgroundSpontaneous rupture is one of the most life-threatening complications of hepatocellular carcinoma (HCC). Transcatheter arterial embolization (TAE) effectively achieves hemostasis in patients with hemodynamic instability. However, there have been no reports of abdominal compartment syndrome (ACS) caused by massive intra-abdominal hematoma after TAE. We report emergency open drainage of a massive hematoma for abdominal decompression and early stage left hepatectomy at the same time.Case presentationA 75-year-old woman was transported to our emergency department with hypovolemic shock. Dynamic contrast-enhanced computed tomography revealed extravasation of contrast medium from a HCC lesion in the medial segment of the liver and a large amount of high-density ascites. TAE was immediately performed to achieve hemostasis. Three hours after the first TAE, we decided to perform a second TAE for recurrent bleeding. After the second TAE, the patient’s intra-abdominal pressure increased to 35 mmHg, her blood pressure gradually decreased, and she had anuria. Thus, she was diagnosed with ACS due to spontaneous HCC rupture. Twenty-seven hours after her arrival to the hospital, we decided to perform open drainage of the massive hematoma and left hepatectomy for ACS relief, prevention of re-bleeding, tumor resection, and intraperitoneal lavage. The operative duration was 225 min, and the blood loss volume was 4626 g. Postoperative complications included pleural effusion and grade B liver failure. She was discharged on postoperative day 33. The patient survived for more than 3 years without functional deterioration.ConclusionsEven after hemostasis is achieved by TAE for hemorrhagic shock due to spontaneous rupture of HCC, massive hemoperitoneum may lead to ACS, particularly in cases of re-bleeding. Considering the subsequent possibility of ACS and the recurrence of bleeding, early stage hepatectomy and removal of intra-abdominal hematoma after hemodynamic stabilization could be a treatment option for HCC rupture.

Development of a prognostic score for recommended transarterial chemoembolization candidates with spontaneous rupture of hepatocellular carcinoma.

Although transarterial chemoembolization (TACE) has been widely used for treating the spontaneous rupture of hepatocellular carcinoma (HCC), no existing model exists for predicting survival. The aim of this study was thus to develop and validate a nomogram for estimating the prognosis in patients with ruptured HCC upon undergoing TACE treatment. This study included 55 patients with spontaneously ruptured HCC who underwent TACE treatment between January 2015 and April 2019. The diagnosis of spontaneous HCC rupture was based on the disruption of the peritumoral liver capsule with surrounding fluid in the perihepatic region. The prognostic nomogram was constructed using the independent predictors assessed by the multivariate Cox proportional hazards model. The median overall survival (OS) was 6.4 months, with 6-month and 1-year survival rates of 52.7% and 41.8%, respectively. In the univariate analysis, the size of the largest tumor, total bilirubin (TBIL) levels, and aspartate aminotransferase (AST) levels were associated with the OS of patients. Multivariate analysis suggested that TBIL levels (HR =0.358, P=0.036) and diameter of the largest tumor (HR =1.012, P=0.044) were independent prognostic factors for predicting the OS. Based on these variables, we developed and validated a nomogram for the risk stratification of HCC rupture after TACE treatment for individual patients. According to the nomogram risk assessment, we were able to evaluate the approximate 1- and 2-year survival rates based on patients' tumor diameter and TBIL level after TACE treatment of ruptured HCC. The concordance index for the OS prediction was 0.748 (95% CI: 0.691-0.805). This newly developed nomogram represents an intuitive tool for predicting the OS of patients with ruptured HCC. This study indicated that TBIL levels and diameter of the largest tumor were independent prognostic factors for predicting the OS of ruptured HCC. This study may help maximize favorable TACE treatment outcomes.

Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature

BackgroundNon-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind.Case presentationA 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum.ConclusionAlthough umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum.

Extremely Severe Hypoglycemia in a Patient Who Experienced Spontaneous Rupture of a Hepatocellular Carcinoma

An 85-year-old woman was brought to the emergency room because of shock and coma. She was found to have extreme hypoglycemia (blood glucose &lt;10 mg/dL), associated with the spontaneous rupture of an endstage Hepatocellular Carcinoma (HCC). Because the patient had declined any treatment for her HCC during the preceding year, no specific treatment was instituted for the ruptured HCC. Intravenous infusion of high-glucose fluid normalized her blood glucose concentration within 4 hours, but she died further 6 hours later. At autopsy, neither insulinoma nor a malignancy other than the HCC was identified. Her liver weighed 1,290 g and was filled with tumor masses. The HCC cells were negative for insulin-like growth factor 2 expression on immunohistochemistry, indicating that the extreme hypoglycemia was not a “Non-Islet Cell Tumor Hypoglycemia (NICHT)”.

Predictors of Spontaneous Rupture of Hepatocellular Carcinoma and Clinical Outcomes Following Hepatectomy.

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.