| Background: Hepatocellular carcinoma is one of the most common primary liver cancers and the third most common cause of death world-wide.Spontaneous rupture is the life-threatening condition of hepatocellular carcinoma.Surgery remains the ideal management of ruptured hepatocellular carcinoma.However,for those who are unable to undergo surgical procedure,Transcatheter arterial chemoembolization(TACE)have been emerges as the best way of management of ruptured hepatocellular carcinoma(HCC)for better survival rate and prognosis in recent years.The purpose of this study was to evaluate and compare the prognostic influence and long term survival rate of spontaneous ruptured HCCs,between surgical resection(emergency Hepatectomy or staged Hepatectomy)and TACE(or staged TACE).Controversy has surrounded the ‘paradigm' of evidence-based medicine since its introduction in 1992 as a new approach to the learning and practice of medicine[1].“real-world evidence” is a health care information from atypical sources,including electronic health records,billing databases,and product and disease registries to assess the safety and effectiveness of drugs and treatments[2].Objective: To analyze the overall long-term Survival rate and factor influencing Survival rate on 85 patients who received five different forms of treatment.Method: Between January 2005 and December 2015,85 patients with hepatocellular carcinoma ruptures were admitted in our hospital and among them 28 patients,who received surgical resection,24 patients received Transarterial chemoembolization,10 patients received conservative treatment,4patients received staged Hepatectomy(Transarterial chemoembolization then surgical resection)and 19 patients received surgical resection plus Transarterial chemoembolization.We retrospectively compared the postoperative morbidity and mortality and overall survival(OS)of patients who received surgical resection,Transarterial chemoembolization,conservative treatment,combination of surgical treatment and TACE and TACE then surgical resection.Independent prognostic predictors were identified using the Cox multivariate regression analysis.Results: Our study of 85 cases showed that,the Overall survival time of 1-,2-,3-,4-,5-years of spontaneous ruptured HCC were 30.6%,18.8%,14.1%,5.9%and 3.5% respectively.In Group A(CT)10 patients with median survival time was 1 months(1-6months).In Group B(SR only)28 patients with median survival time was18 months(1-122months)and the 1-,2-,3-,4-,5-year survival analyses were 42.9%,42.9%,21.4%,10.7% and 3.5% respectively.In Group C(SR+TACE)19 patients the median survival time was 24 months(2-90months).And the 1-,2-,3-,4-,5-years survival analyses were 47.4%,42.1%,36.8%,31.5% and 5.3%.In Group D(TACE only)24 patients with median survival time was 14 months(1-124months)and the 1-,2-,3-,4-,5-years survival analyses were 12.5%,4.2%,4.2%,4.2% and 4.2% respectively.In Group E(TACE+SR)because the number of patients was very few(4 patients)the median range of survival time was 49 months(5-53months).And the 1-,2-,3-,4-,5-years survival analyses were 50%,50%,25%,25% and 0% respectively.By Cox regression analysis of multiple factors showed that,alcohol consumptions and preoperative serum AFP value has a significant influence on overall survival time.Conclusions: Patients with spontaneous ruptured hepatocellular carcinoma with serum AFP?400ng/ml,higher AST level,history of Alcohol consumption and presence of local invasion had worst survival time.And patients without above mentioned factor with curative treatments(SR+TACE;SR only;TACE;TACE+SR)had favorable long-term outcomes.More advanced treatment strategies may benefit patients with spontaneous rupture of hepatocellular carcinoma,compared with patients who receive conservative treatment. |
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