Abstract
Purpose
Spontaneous rupture is a fatal complication of hepatocellular carcinoma (HCC). This study compared the prognosis of spontaneously ruptured HCC (srHCC) with that of non-ruptured HCC (nrHCC).
Methods
A total of 185 srHCC patients and 1085 nrHCC patients treated by hepatectomy between February 2005 and December 2017 at Zhongshan Hospital were retrospectively reviewed and enrolled. The overall survival (OS) and time to recurrence (TTR) were evaluated. A 1:2 propensity score matching (PSM) analysis was performed using the nearest neighbor matching with a caliper of 0.2.
Results
Before PSM, patients with srHCC who underwent hepatectomy (n = 185) had a poorer prognosis than those with nrHCC (n = 1085; 5-year OS, 39.1% vs 59.2%, P < 0.001; 5-year TTR, 83.8% vs 54.9%, P < 0.001). After PSM, patients with srHCC (n = 156) had higher 5-year TTR (83.2% vs 69.0%, P < 0.001) but comparable 5-year OS with those with nrHCC (n = 312, 44.0% vs 46.0%, P = 0.600). Univariate and multivariate analyses demonstrated spontaneous rupture as an independent risk factor for TTR (hazard ratio [HR], 1.681; 95% confidence interval [CI] 1.326–2.132; P < 0.001), but not for OS (HR: 1.074; 95% CI 0.823–1.401; P = 0.600). Further analysis revealed that srHCC was not appropriate to be assigned as T4 stage in American Joint Committee on Cancer classification.
Conclusion
Spontaneous rupture of HCC is not a risk factor for survival. If resected eventually, srHCC may achieve comparable survival with nrHCC.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
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Funding
This study was jointly supported by the National Key R&D Program of China (2019YFC1315800, 2019YFC1315802), National Natural Science Foundation of China (No.81830102, 81772578, 81802991), and Shanghai Municipal Key Clinical Specialty.
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AH, JZ and S-YZ conceptualized this study and wrote the manuscript. S-YZ and D-ZG conducted data analysis. XZ collected the clinical information of patients. AH, JZ and JF interpreted the data. All authors edited the manuscript. All authors contributed to the article and approved the submitted version.
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This retrospective study has been censored and approved by the scientific research department of Zhongshan Hospital, Fudan University.
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Zhang, SY., Guo, DZ., Zhang, X. et al. Prognosis of spontaneously ruptured hepatocellular carcinoma: a propensity score matching study. J Cancer Res Clin Oncol 149, 8889–8896 (2023). https://doi.org/10.1007/s00432-023-04774-3
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DOI: https://doi.org/10.1007/s00432-023-04774-3