Clinical Treatment And Prognosis Of Patients With Ruptured Hepatocellular Carcinoma

Purpose: To validate if partial hepatectomy can achieve a better prognosis by propensity score matching(PSM)than non-surgical treatments in patients with hepatocellular carcinoma rupture.Methods: A total of 216 patients with HCC ruptures in our center were included.Among these,130 patients received(emergency or staged)partial hepatectomy,and 86 patients were treated with non-surgical treatment.Propensity score matching(PSM)was used to adjust for differences in baseline patient characteristics.Univariate and multivariate analyses of factors affecting long-term survival were conducted.Results: Before PSM,the median survival time was 13.7(IQR 7.2–35.4)months and 2.5(IQR 0.5–7.4)months in the partial hepatectomy group and non-surgical treatment group,respectively.Non-surgical was associated with a worse overall survival(OS)in both univariate(HR 3.756,95 percent CI 2.766 to 5.101;P < 0.001)and multivariate analysis(HR 3.141,95 percent CI 2.198 to 4.488;P < 0.001).After PSM,these two groups were well balanced(35 patients in each group).Overall median survival in the partial hepatectomy group was better(HR 3.029,95 percent CI 1.745 to 5.258;P < 0.001)than that for patients receiving non-surgical treatment(15.0 versus 3.2 months respectively).Multivariable analysis showed that non-surgical treatment was an independent risk factor of poor OS(HR 2.792,95 percent CI 1.581 to 4.930;P < 0.001).Conclusion: Treatment strategies that include liver resection could offer a survival benefit compared with non-surgical treatment alone for patients with ruptured HCC.Purpose: Liver resection has been applied to treat patients with HCC with tumor rupture.It is contentious whether the patients should receive emergency partial hepatectomy(Em PH)once rupture,or the treatment to achieve hemostasis should be implemented initially,then followed by staged early or delayed partial hepatectomy when their condition becomes stable.Methods: A total of 10-year patients with tumor rupture were incorporated into this study.Patients who underwent partial hepatectomy were further subdivided into the Em PH group,the staged early partial hepatectomy(SEPH)group,and the staged delayed partial hepatectomy(SDPH)group.Recurrence free survival(RFS),OS,peritoneal metastatic rates and postoperative mortality were compared.COX regression was carried out to determine the risk factors of peritoneal dissemination.Results: These 130 patients who received partial hepatectomy were further subdivided into the Em PH group(surgery at the time of rupture,n=30),the SEPH group(surgery ￡ 8 days of rupture,n=67),and the SDPH group(surgery > 8 days of rupture,n=33).For resectable tumor,the thirty-day mortality,OS,and RFS were comparable between the Em PH group,and the staged partial hepatectomy(SPH)group which consisted of those who received SEPH and SDPH.The SEPH group presented significantly better OS and RFS.Multivariate COX analysis demonstrated that SDPH was an intensively independent risk factor of postoperative peritoneal dissemination.Conclusion: Early partial hepatectomy within eight days of tumor rupture(included Em PH and SEPH)can lead to less peritoneal dissemination and better postoperative survival outcomes(especially RFS)than SDPH.Purpose: HCC rupture is lethal once occurred,and tumor resection can achieve a favorable survival than other strategies of tumor rupture.To this day,however,there is no accessible prognostic scoring system for patients with tumor rupture who received partial hepatectomy.This study aimed to develop a new prognostic scoring system for patients with ruptured HCC who were treated with liver resection.Methods: There are 129 patients with spontaneous HCC rupture altogether who received partial hepatectomy from January 2005 to May 2015.Preoperative clinical materials were used to data collection and analysis.Independent risk factors of overall survival(OS)in COX regression were used as components of this new system.C index(also called Harrell’s C statistics),Akaike information criterion(AIC),the relative likelihood,and the log likelihood ratio were calculated to measure the homogeneity and discriminatory ability of a prognostic system.Results: Three factors,in the multivariable Cox regression analysis,including tumor size,preoperative AFP level,and alkaline phosphatase(ALP)level,were chosen for the new tumor-associated antigen(TAA)scoring system.The 1-year OS rates were 88.1%,43.2%,and 30.2% for TAA scores of 0 to 5 points(low-risk group),6 to 9 points(moderate-risk group),and 10 to 13 points(high-risk group),respectively.The TAA scoring system(Harrell’s C statistics,0.693;AIC,794.79;log likelihood ratio,45.21)had superior homogeneity and discriminatory ability than the Barcelona Clinic Liver Cancer staging system(Harrell’s C statistics,0.627;AIC,817.23;log likelihood ratio,22.7;relative likelihood,< 0.001)and the Cancer of the Liver Italian Program(Harrell’s C statistics,0.634;AIC,820.16;and log likelihood ratio,21.84;relative likelihood,< 0.001)in predicting OS.Similar findings could be observed in predicting disease-free survival(DFS).Conclusion: In predicting both OS and DFS of patients with spontaneous ruptured HCC,this new scoring system is considered simple and practicable.