Ruptured hepatocellular carcinoma and non-alcoholic fatty liver disease, a potentially life-threatening complication in a population at increased risk

Nuño-Guzmán, Carlos M.; Marín-Contreras, María Eugenia

doi:10.1016/j.aohep.2019.11.001

Cited by 5 publications

(8 citation statements)

References 14 publications

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“…2,3,6,8,9 NAFLD represents the largest proportion of new HCC cases without advanced fibrosis or cirrhosis in the United States; however, there is no consensus on which patients with NAFLD would benefit from HCC surveillance. 21 Although some studies have suggested that the incidence of ruptured HCC is decreasing with improved surveillance, [2][3][4]6 our study did not show this. Despite more HCC found with surveillance and a smaller proportion with large tumors over time, we identified an increased proportion of HCC patients with NAFLD/NASH, as well as with metabolic risk factors such as diabetes, hyperlipidemia, obesity, and morbid obesity, and less with underlying cirrhosis.…”

Section: Discussioncontrasting

confidence: 69%

“…Stable patients can be monitored closely and prepared for definitive treatment with surgical resection or locoregional therapy. 2,4,8,20,21 Although the laparoscopic approach to liver resection is well accepted in HCC, its use in ruptured cases has not been well defined. 22 In our cohort, more than half of the patients were initially managed with TAE, and half of these underwent subsequent treatment either by staged liver resection or other therapies, whereas the remaining patients did not receive any subsequent treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, although the incidence of HCC is increasing in the West, likely due to underlying NAFLD and NASH, 1,3,21 the incidence of spontaneous rupture is still uncommon at less than 3% compared with Asia where the incidence has been as high as 26%. 2,3,6,8,9 NAFLD represents the largest proportion of new HCC cases without advanced fibrosis or cirrhosis in the United States; however, there is no consensus on which patients with NAFLD would benefit from HCC surveillance.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Obeidat

2022

Journal of Clinical and Experimental Hepatology

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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.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Obeidat

2022

Journal of Clinical and Experimental Hepatology

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“…A study [3] reported that for patients with ruptured and hemorrhagic hepatocellular carcinoma who could not be resected by emergency surgery, the application of TAE for hemostasis was e ective and could prolong the postoperative survival time of the patients. At present, there are many reports about liver resection and TAE in the treatment of primary liver cancer spontaneous rupture and hemorrhage [4][5][6], but there is no uni ed guideline for the selection of surgical methods for ruptured hemorrhage of primary liver cancer. erefore, this study explored the short-term and long-term curative effects of partial hepatectomy on ruptured hemorrhage of primary liver cancer after TAE in order to provide more evidence-based data support for the selection of surgical options for the clinical treatment of ruptured hemorrhage of primary liver cancer.…”

Section: Introductionmentioning

confidence: 99%

Short-Term and Long-Term Curative Effect of Partial Hepatectomy on Ruptured Hemorrhage of Primary Liver Cancer after TAE

Xiao

Zhou

Zhang

et al. 2022

Emergency Medicine International

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Objective. To observe the short-term and long-term curative effects of partial hepatectomy on ruptured hemorrhage of primary liver cancer after transcatheter arterial embolization (TAE). Methods. A total of 150 patients with primary liver cancer treated in the hospital were enrolled as research objects between February 2018 and February 2021, including 75 cases undergoing TAE in the TAE group and the other 75 cases undergoing elective partial hepatectomy after TAE in the combination group. The surgical related indexes (leaving bed time, discharge time, success rate of hemostasis, lesion clearance rate), mean arterial pressure (MAP), heart rate (HR), hemoglobin, and liver function indexes (serum alpha-fetoprotein (AFP), albumin (ALB), total bilirubin (TBIL)) before and after treatment, postoperative complications, survival rate, and recurrence rate at 1 year after surgery between the two groups were compared. Results. Compared with the TAE group, hospitalization time was shorter ( P < 0.05 ), the success rate of hemostasis and lesions clearance rate were higher in the combination group ( P < 0.05 ). After surgery, levels of HR and serum AFP were significantly decreased, while levels of MAP, hemoglobin, serum ALB, and TBIL were significantly increased in both groups. The levels of HR and serum AFP in the combination group were lower than those in the TAE group, while levels of MAP, hemoglobin, serum ALB, and TBIL were higher than those in the TAE group ( P < 0.05 ). There was no significant difference in the incidence of postoperative complications between the two groups ( P < 0.05 ). Compared with the TAE group, the recurrence rate was lower, and the survival rate was higher in the combination group at 1 year after surgery ( P < 0.05 ). Conclusion. Partial hepatectomy can effectively improve hemostatic effect and liver function in ruptured hemorrhage of primary liver cancer after TAE, increase survival rate, and reduce postoperative recurrence rate.

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“…In the previous literature, many investigators believe that ( 10 ) once HCC ruptures, the prognosis is very poor, and in TNM staging, patients with rHCC are directly included in T4. However, in recent years, the results of some studies and our own clinical experience suggest that rHCC patients can also achieve a better prognostic status through active treatment.…”

Section: Introductionmentioning

confidence: 99%

Ruptured Hepatocellular Carcinoma: Current Status of Research

et al. 2022

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BackgroundRuptured hepatocellular carcinoma (rHCC) is considered a rare and life-threatening manifestation; when it happens, it often requires acute and positive intervention. At present, the mechanism of rHCC development is gradually being understood while there are many kinds of rHCC treatment. From our clinical observation, the prognosis of rHCC patients is not as poor as it is currently believed. It may not be appropriate to include all patients with rHCC in T4.Main BodyThe incidence of ruptured hepatocellular carcinoma is now rising. Especially in the Asian region, it can even reach 10% – 15%. The most common symptom of HCC rupture is abdominal pain, and there are now a variety of treatments for hepatocellular carcinoma rupture. With aggressive treatment, rHCC patients can also achieve a better prognosis. The patient’s condition varies on admission, so the treatment methods will also be different. It is critical to identify prognostic factors simultaneously, and rHCC can be effectively managed by focusing on important prognostic factors.ConclusionA review was carried out to analyze diagnosis, mechanism, treatment, and prognostic risk factors on this disease condition during the current situation; it is hoped that it will provide better guidance for clinicians. Moreover, patients with rHCC were managed hierarchically to prolong their prognosis.

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Ruptured hepatocellular carcinoma and non-alcoholic fatty liver disease, a potentially life-threatening complication in a population at increased risk

Cited by 5 publications

References 14 publications

Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

Short-Term and Long-Term Curative Effect of Partial Hepatectomy on Ruptured Hemorrhage of Primary Liver Cancer after TAE

Ruptured Hepatocellular Carcinoma: Current Status of Research

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