Impact of spontaneous rupture on the survival outcomes after liver resection for hepatocellular carcinoma: A propensity matched analysis comparing ruptured versus non-ruptured tumors

Chua, Denise Qian Ling; Koh, Ye‐Xin; Allen, John C.; Chan, Chung‐Yip; Lee, Ser‐Yee; Cheow, Peng‐Chung; Jeyaraj, Prema Raj; Teo, Jin‐Yao; Chow, Pierce K.H.; Chung, Alexander Y. F.; Ooi, London Lucien; Goh, Brian K. P.

doi:10.1016/j.ejso.2019.03.044

Cited by 35 publications

(45 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A number of factors that are independently related to rHCC have been identified by previous studies, further strengthening the confidence with which APAS score might be applied in clinical practice. Consistent associations were shown for PFLS and tumor size of >5 cm [ 2 12 ]. Tumor size has been recognized as an important risk factor for spontaneous rupture, although this may be due to other related variables, such as vascular invasion and tumor grade, rather than the absolute maximum tumor size [ 12 13 ].…”

Section: Discussionsupporting

confidence: 53%

“…Consistent associations were shown for PFLS and tumor size of >5 cm [ 2 12 ]. Tumor size has been recognized as an important risk factor for spontaneous rupture, although this may be due to other related variables, such as vascular invasion and tumor grade, rather than the absolute maximum tumor size [ 12 13 ]. HCC patients with PFLS had an increased risk of rHCC, as compared with other tumor locations [ 7 14 ].…”

Section: Discussionsupporting

confidence: 53%

See 1 more Smart Citation

Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma

Gong

et al. 2020

Ann Surg Treat Res

View full text Add to dashboard Cite

Purpose Spontaneous rupture is a potentially serious complication of liver cancer. A risk score was developed and validated for predicting spontaneous rupture based on a retrospective study. Methods Multiple logistic regression analysis was used to study the relationship between clinical variables and spontaneous rupture. The independent rupture predictors were converted into a score based on the odds ratio. Predicted attributes of the developed scores were then verified using a dataset in 2019. Results The incidence of spontaneous rupture was 5.5% from 2002 to 2019. A 10-point score (α-FP of ≥400 µg/L, 1; protrusion from liver surface, 2; ascites, 3; tumor size of >5 cm, 4) was derived for prediction of rupture and area under the receiver-operating characteristic curve was 0.9 (95% confidence interval, 0.87–0.92). When applying a cutoff value of 5 points or more, the specificity was 0.87 and the sensitivity was 0.84. A validation cohort consisting of 202 hepatocellular carcinoma patients reproduces the predictive, identification, and calibration characteristics. The observed rate of spontaneous rupture according to risk stratification of the score was 0.6% for those with a score of 0–4, 21.6% for a score of 5–7, and 36.4% for a score of 8–10 in the validation cohort. Conclusion Here, based on routine clinical data, we determine the factors that affect prognosis and propose an effective tool for predicting spontaneous rupture, which may be useful in guiding priority treatment of high-risk patients or clinical routine preventive treatment.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussionsupporting

confidence: 53%

Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma

Gong

et al. 2020

Ann Surg Treat Res

View full text Add to dashboard Cite

show abstract

“…Previous studies have suggested that patients who underwent liver resection after ruptured HCC had comparable outcomes with nonruptured cases. Specifically, Chua et al 23 in a propensity matched comparison of 47 ruptured and 98 nonruptured cases who underwent liver resection, found no difference in 5-year overall and disease-free survival and hospital length of stay. However, these patients had large tumors with mean size of 8.5-9.5 cm.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Obeidat

2022

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Background: Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially fatal complication and the third leading cause of death in patients with HCC after tumor progression and liver failure. Previous studies suggested that improved HCC surveillance has decreased the incidence of rupture. This study aims to characterize patients with ruptured HCC over time and identify predictors of rupture. Methods: We retrospectively reviewed a prospectively collected database of 1451 HCC patients to identify cases with rupture and predictors of rupture. Data were divided into three 9-year eras to compare and trend patient/tumor characteristics and rupture. Results: Fifty-seven patients (3.9%) presented with spontaneous HCC rupture and the following characteristics: mean age 62.6 years, 73.7% males, 41% cirrhosis, and mean tumor size of 8.0 cm. On multivariate analyses, predictors of rupture included obesity, tumor >5 cm, and single tumors, whereas the presence of cirrhosis was a negative predictor for rupture.Across three eras, there were changes in disease etiology and decreases in tumor size, and more HCCs were found with surveillance. However, more patients were noncirrhotic, and the incidence of spontaneous rupture was unchanged over time. Conclusion: Despite improved early detection of HCC over time, the incidence of rupture has been unchanged. The persistent incidence of rupture may possibly be attributed to increasing proportion of fatty liver-related HCC patients who lack traditional risk factors for surveillance and may not have cirrhosis. Better identification of fatty liver disease and determining which patients need HCC surveillance may be needed in the future to prevent spontaneous rupture.

show abstract

“…In general, curative options such as LR, liver transplant (LT) or ablation were offered whenever possible. Our institution in general adopted an aggressive resection approach towards HCC, performing LR for large cancers, ruptured cancers, recurrent cancers and multifocal HCC and these experiences have been reported previously 12‐16 . LT was offered as the treatment modality of choice to many of these patients but due to the severe shortage of deceased donor organs in our country, living donor (LD) LT is frequently the only viable option for HCC patients.…”

Section: Methodsmentioning

confidence: 95%

“…Our institution in general adopted an aggressive resection approach towards HCC, performing LR for large cancers, ruptured cancers, recurrent cancers and multifocal HCC and these experiences have been reported previously. [12][13][14][15][16] LT was offered as the treatment modality of choice to many of these patients but due to the severe shortage of deceased donor organs in our country, living donor (LD) LT is frequently the only viable option for HCC patients. However, due to local cultural reasons unlike other Asian countries such as Japan and Korea, the use of LDLT also remains limited.…”

Section: Methodsmentioning

confidence: 99%

Actual 10‐year survivors and 10‐year recurrence free survivors after primary liver resection for hepatocellular carcinoma in the 21st century: A single institution contemporary experience

Linn

Chee

Koh

et al. 2020

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background: At present, the majority of outcome studies of survival of hepatocellular carcinoma (HCC) post-liver resection (post-LR) present actuarial survival data, which often results in overestimation of survival. We sought to evaluate the actual 10-year survival post-LR for HCC and identify variables that are associated with long-term survival. Methods: We performed a retrospective review of 600 consecutive patients who underwent primary LR for HCC from 2000 to 2010 at our institution. Twenty-eight patients (4.7%) with 90-day mortality and 125 patients who were lost to follow-up within 10 years were excluded leaving 447 patients who met the study criteria. Results: There were 140 actual 10-year survivors of which 57 (40.7%) had a recurrence within 10 years. The actual 10-year overall survival (OS) rate of the 447 patients was 31.5% and the actual 10-year recurrence-free survival (RFS) was 18.6%. Multivariate analyses demonstrated that only age >65 years (OR, 0.29; p < .001) (OR, 0.973; p = .041) and presence of cirrhosis (OR. 0.37; p = .005) (OR, 0.31; p = .001) were independent factors negatively associated with actual 10-year OS and actual 10-year RFS, respectively. Conclusion: Approximately one-third of patients will survive over 10 years after LR for HCC. Amongst these 10-year survivors, 41% had developed recurrent cancer within 10-years of follow-up.

show abstract

Impact of spontaneous rupture on the survival outcomes after liver resection for hepatocellular carcinoma: A propensity matched analysis comparing ruptured versus non-ruptured tumors

Cited by 35 publications

References 50 publications

Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma

Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma

Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Actual 10‐year survivors and 10‐year recurrence free survivors after primary liver resection for hepatocellular carcinoma in the 21st century: A single institution contemporary experience

Contact Info

Product

Resources

About