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Outcomes and Prognostic Factors of Spontaneously Ruptured Hepatocellular Carcinoma

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Spontaneous tumor rupture is a rare and life-threatening complication of hepatocellular carcinoma (HCC). The best treatment strategy remains unclear.

Methods

The clinical data of 137 patients with spontaneously ruptured HCC from 2010 to 2015 were reviewed retrospectively. We investigated the outcome and prognostic factors of various treatment strategies.

Results

Of the 137 patients, 53, 45, 3, and 36 patients underwent transcatheter arterial chemoembolization (TACE) alone, liver resection (LR) (LR alone or TACE + LR), surgical hemostasis, and conservative therapy. The patients undergoing LR had longest overall survival (OS). In the TACE alone group, independent factors affecting 30-day mortality were MELD score ≥ 12, AFP ≥ 1000 ng/ml, and largest tumor size ≥ 10 cm. AFP ≥ 1000 ng/ml, largest tumor size ≥ 10 cm, and no tumor capsule were significantly associated with poorer OS. In the LR group, largest tumor size ≥ 10 cm and no tumor capsule were the only independent prognostic factors for poorer OS and recurrence-free survival (RFS). Hypovolemic shock was an independent prognostic factor for poorer OS. The differences in OS between the TACE + LR group and LR alone group were not significant (P = 0.955). However, the RFS is significantly better in the LR alone group than those in the TACE + LR group (P = 0.031).

Conclusion

For resectable tumor, LR is the treatment of choice for patients with spontaneous ruptured HCC and preserved liver function. The delay in LR due to preoperative TACE may account for its worse RFS compared with LR alone. In patients with an unresectable tumor, TACE therapy alone improved survival over conservative therapy.

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Abbreviations

HCC:

Hepatocellular carcinoma

TACE:

Transcatheter arterial chemoembolization

RFA:

Radiofrequency ablation

CT:

Computed tomography

CTP:

Child–Turcotte–Pugh

MELD:

Model for End-stage Liver Disease

BCLC:

Barcelona Clinic Liver Cancer

AJCC:

American Joint Committee on Cancer

ECOG:

Eastern Cooperative Oncology Group

ICG15:

Indocyanine green retention rate at 15 min

IVC:

Inferior vena cava

OS:

Overall survival

RFS:

Recurrence-free survival

LR:

Liver resection

PT:

Prothrombin time

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

TB:

Total bilirubin

AFP:

Alpha-fetoprotein

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

PVTT:

Portal vein tumor thrombosis

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Authors and Affiliations

  1. Department of Surgery, Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People’s Republic of China

    Wei Zhang, Zhi-Wei Zhang, Bi-Xiang Zhang, Zhi-Yong Huang, Wan-Guang Zhang, Hui-Fang Liang & Xiao-Ping Chen

  2. Key Laboratory of Organ Transplantation, Ministry of Education and Key Laboratory of Organ Transplantation, Ministry of Public Health, Wuhan, China

    Xiao-Ping Chen

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  1. Wei Zhang
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Contributions

Design of work: W.Z., X.-P.C.

Acquisition, analysis, and interpretation of data: W.Z., W.-G.Z.; H.-F.L., X.-P.C.

Drafting and revising: W.Z., Z.-W.Z., B.-X.Z., Z.-Y.H.

Final approval: W.Z., X.-P.C.

Agreement to be accountable for all aspects of the work: W.Z., Z.-W.Z., B.-X.Z., Z.-Y.H., W.-G.Z., H.-F.L., X.-P.C.

Corresponding author

Correspondence to Xiao-Ping Chen.

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Zhang, W., Zhang, ZW., Zhang, BX. et al. Outcomes and Prognostic Factors of Spontaneously Ruptured Hepatocellular Carcinoma. J Gastrointest Surg 23, 1788–1800 (2019). https://doi.org/10.1007/s11605-018-3930-7

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  • DOI: https://doi.org/10.1007/s11605-018-3930-7

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