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

Abstract

Background: This study aims to find out the possible optimal therapy and assess the prognosis properly for patient with spontaneous rupture of hepatocellular carcinoma (HCC).Methods: 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.Results: 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.Conclusions: 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.

Nomogram for Estimation of Acute Liver Failure Risk in Spontaneous Ruptured Hepatocellular Carcinoma

“…However, this outcome remains significantly worse than that observed in treated HCC cases. 3,24 Liver failure significantly contributes to mortality in patients with SRHCC and is particularly linked to increased short-term mortality rates. 25,26 Our findings indicate that 63.1% of patients experiencing ALF died within one month, and the one-year survival rate was a mere 8.7%.…”

“…While recent studies have reported a decline in mortality rates, it remains a challenging issue within the realm of hepatobiliary surgery. [3][4][5][6][7] Acute liver failure (ALF) frequently contributes to mortality in end-stage liver disease, a trend similarly observed in patients with SRHCC. 5,8 During the acute phase of the disease, ALF incidence ranges from 12% to 42%.…”

Comparison of post-resection survival between hepatocellular carcinoma patients in BCLC stage A or B who experience tumor rupture and patients in BCLC stage C who do not

“…Hepatocellular carcinoma (HCC) is the sixth most common and the third most deadly malignant tumor in the world [ 1 ]. Although HCC tumors spontaneously rupture in fewer than 3% of patients in the West, rupture occurs in 2–26% of patients in Asia [ [2] , [3] , [4] , [5] , [6] , [7] ]. Studies have found that even if ruptured HCC patients can be managed promptly in the event of a critical situation, their long-term prognosis is worse than that of non-ruptured HCC [ [8] , [9] , [10] ].…”

Do we really need a standardized approach to spontaneously ruptured hepatocellular carcinoma?

“…Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in Asian and African countries due to a high prevalence of chronic hepatitis B infections ( 1 , 2 ). The vast majority of current studies focus on the treatment of HCC itself rather than complications from HCC.…”