Surgical Outcomes of Spontaneously Ruptured Hepatocellular Carcinoma

Kwon, Jae‐Hyun; Song, Gi-Won; Hwang, Shin; Kim, Ki‐Hun; Ahn, Curie; Moon, Deok‐Bog; Ha, Tae‐Yong; Jung, Dong‐Hwan; Park, Gil‐Chun; Yoon, Young‐In; Shim, Ju Hyun; Kim, Kyong Won; Lee, Sung‐Gyu

doi:10.1007/s11605-020-04555-0

Cited by 24 publications

(21 citation statements)

References 35 publications

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“…After removing duplicates, 2,952 records remained. Twenty-one studies (13,18,19,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were ultimately included following a strict screening process. The comprehensive literature review and rigorous selection process are displayed in Figure 1.…”

Section: Data Collection and Characteristicsmentioning

confidence: 99%

Prognostic Influence of Spontaneous Tumor Rupture in Patients With Hepatocellular Carcinoma After Hepatectomy: A Meta-Analysis of Observational Studies

Hong

Zhou

et al. 2021

Front. Surg.

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Objective: This study aims to comprehensively analyze the influence of spontaneous tumor rupture on the prognosis of hepatocellular carcinoma patients following hepatic resection.Methods: We systematically searched four online electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, for eligible studies published from inception to March 2021. The main endpoints were overall survival (OS) and disease-free survival (DFS).Results: This meta-analysis included 21 observational articles with 57,241 cases. The results revealed that spontaneous tumor rupture was associated with worse OS (hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.33–2.05) and DFS (HR, 1.42; 95% CI, 1.12–1.80) in resectable hepatocellular carcinoma patients. This phenomenon was observed in most subgroups, which were classified by recorded survival time, age, country, alpha-fetoprotein (AFP) concentration, liver cirrhosis, and microvascular invasion. However, in subgroups of macrovascular invasion positive, spontaneous tumor rupture was not a risk factor for OS (HR, 1.55; 95% CI, 0.99–2.42) and DFS (HR, 1.23; 95% CI, 0.91–1.65) in hepatocellular carcinoma patients after hepatectomy. For macrovascular invasion negative, compared with non-ruptured hepatocellular carcinoma patients, ruptured hepatocellular carcinoma patients exhibited worse prognosis for OS (HR, 1.55; 95% CI, 0.99–2.42) and DFS (HR, 1.23; 95% CI, 0.91–1.65) following hepatectomy.Conclusions: Spontaneous tumor rupture was a prognostic risk factor for hepatocellular carcinoma patients after hepatic resection. However, in macrovascular invasion patients, spontaneous tumor rupture was not a prognostic risk factor.

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Section: Data Collection and Characteristicsmentioning

confidence: 99%

Prognostic Influence of Spontaneous Tumor Rupture in Patients With Hepatocellular Carcinoma After Hepatectomy: A Meta-Analysis of Observational Studies

Hong

Zhou

et al. 2021

Front. Surg.

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“…[9][10][11] Spontaneous HCC rupture might be related to the rapid growth of the tumor leading to intratumor necrosis and tumor vascular hyperplasia, with vascular dysfunction caused by the degeneration of the vessel structure composition (elastin, collagen IV). 12,13 The current treatment strategy for patients with spontaneous HCC rupture remains controversial. At present, surgical treatments such as emergent liver resection, injection of absolute alcohol, hepatic artery ligation, and transcatheter arterial embolization (TAE) are available for HCC patients with spontaneous rupture bleeding.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of Artificial Neural Networks for Survival Prediction Model for Patients with Spontaneous Hepatocellular Carcinoma Rupture After Transcatheter Arterial Embolization

Qiu¹,

Wang²,

Shen³

et al. 2021

CMAR

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Background Spontaneous rupture bleeding is a fatal hepatocellular carcinoma (HCC) complication and a significant determinant of survival outcomes. This study aimed to develop and validate a novel artificial neural network (ANN)-based survival prediction model for patients with spontaneous HCC rupture after transcatheter arterial embolization (TAE). Methods Patients with spontaneous HCC rupture bleeding who underwent TAE at our hospital between January 2010 and December 2018 were included in our study. The least absolute shrinkage and selection operator (LASSO) Cox regression model was used to screen clinical variables related to prognosis. We incorporated the above clinical variables identified by LASSO Cox regression into the ANNs model. Multilayer perceptron ANNs were used to develop the 1-year overall survival (OS) prediction model for patients with spontaneous HCC ruptured bleeding in the training set. The area under the receiver operating characteristic curve and decision curve analysis were used to compare the predictive capability of the ANNs model with that of existing conventional prediction models. Results The median survival time for the whole set was 11.8 months, and the 1-year OS rate was 47.5%. LASSO Cox regression revealed that sex, extrahepatic metastasis, macroscopic vascular invasion, tumor number, hepatitis B surface antigen, hepatitis B e antigen, tumor size, alpha-fetoprotein, fibrinogen, direct bilirubin, red blood cell, and γ-glutamyltransferase were risk factors for OS. An ANNs model with 12 input nodes, seven hidden nodes, and two corresponding prognostic outcomes was constructed. In the training set and the validation set, AUCs for the ability of the ANNs model to predict the 1-year OS of patients with spontaneous HCC rupture bleeding were 0.923 (95% CI, 0.890–0.956) and 0.930 (95% CI, 0.875–0.985), respectively, which were higher than that of the existing conventional models (all P < 0.0001). Conclusion The ANNs model that we established has better survival prediction performance.

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“…Several studies have reported that tumor rupture should add 0.5 to 2 stages to the baseline TNM stage; however, aggressive surgical resection of ruptured HCC can still be effective in prolonging patient survival. [ 4 , 5 ] Yang et al also found that patients with HCC who experienced the rupture after hepatectomy had significantly higher survival rates than those who did not undergo hepatectomy. [ 17 ] In the present study, the median survival was 23 months (IQR: 17–38).…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of surgical treatment for the spontaneously ruptured resectable hepatocellular carcinoma: A single institution experience

Ryu

Choi

et al. 2022

Medicine

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Spontaneously ruptured hepatocellular carcinoma (srHCC) is a fatal complication of hepatocellular carcinoma (HCC). In addition, emergency treatment is frequently fraught with difficulties. This study aimed to investigate the prognosis and recurrence pattern in patients undergoing hepatectomy for the srHCC. This retrospective study included 11 patients with srHCC treated using either emergency hepatectomy or emergency transarterial embolization (TAE) followed by staged hepatectomy between January 2015 and December 2019. The patients visited the emergency room because of a sudden rupture of HCC without being diagnosed with HCC. We analyzed the prognosis, recurrence rate, and survival in these patients after hepatectomy. Four of the 11 patients in this study were classified as Child–Pugh class A and 7 as Child–Pugh class B. Nine patients visited for sudden onset of abdominal pain, and 2 for sudden onset of shock. The median hemoglobin level at the time of the visit was 11.5 g/dL (interquartile range: 9.8–12.7). Five patients underwent one-stage hepatectomy and 6 underwent emergency TAE hemostasis followed by staged hepatectomy. Median overall survival and recurrence-free survivals were 23 and 15 months, respectively. Recurrence occurred in 7 patients (4 in the one-stage group and 3 in the staged group). Among patients with recurrence, 6 had intrahepatic recurrence and 3 peritoneal metastases. Patients with srHCC who undergo staged hepatectomy can achieve a relatively good prognosis. The most common sites of recurrence after hepatectomy are intrahepatic and peritoneal. Peritoneal metastases are more likely to occur after one-stage hepatectomy.

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Surgical Outcomes of Spontaneously Ruptured Hepatocellular Carcinoma

Cited by 24 publications

References 35 publications

Prognostic Influence of Spontaneous Tumor Rupture in Patients With Hepatocellular Carcinoma After Hepatectomy: A Meta-Analysis of Observational Studies

Prognostic Influence of Spontaneous Tumor Rupture in Patients With Hepatocellular Carcinoma After Hepatectomy: A Meta-Analysis of Observational Studies

Development and Validation of Artificial Neural Networks for Survival Prediction Model for Patients with Spontaneous Hepatocellular Carcinoma Rupture After Transcatheter Arterial Embolization

Clinical impact of surgical treatment for the spontaneously ruptured resectable hepatocellular carcinoma: A single institution experience

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