Clinical Management And Prognosis Of Primary Hepatocellular Carcinoma Rupture And Bleeding

Background:The rupture of primary hepatocellular carcinoma(HCC)is a relatively common late complication,emergency liver resection is used to be adopted in the past,a two-step treatment plan for partial hepatectomy after conservative treatment or transcatheter arterial embolization(TAE)has been proposed and applied in recent years.However,in the case where both can be used,which solution can achieve better prognosis still needs to be studied.Methods:From January 2005 to December 2014,50 patients with HCC rupture admitted to our Liver Cancer Research Center underwent hepatectomy after conservative hemostasis,hepatectomy after TAE hemostasis,or acute liver resection.There were divided into two groups,two-step and emergency liver resection,to retrospectively analyze short-term survival outcomes,overall survival(OS),and disease-free survival(DFS).Cox regression models were used to determine independent predictors of postoperative survival and tumor recurrence.Results:The short-term survival outcomes such as transfusion requirements(p<0.001),major complications(p<0.001),postoperative hospital stay(p=0.001),and hospital mortality(p=0.029)in the emergency hepatectomy group were poorer in comparison to the two-step treatment group.The 1-,3-,and 5-year OS rates of patients with HCC rupture in the two-step group were 68.7%,47.3%,and 26.3%,respectively,whereas they were 37.5%,23.4%,and 23.4%,respectively(p=0.038)in the emergency hepatectomy group.However,there was no significant difference in the tumor-free survival rate between the emergent resection group and the two-step group(p=0.233).Univariate and multivariate analyses of patients with HCC rupture showed that AFP>400 ?g/L and microvascular infiltration were independent risk factors for postoperative survival and poor prognosis(HR=4.071,p=0.001;HR=6.352,p<0.001)as well as tumor-free survival(HR=2.634,p=0.009;HR=7.460,p<0.001)Conclusion:In the case of liver function Child-Pugh below C,without serious basic disease,current life signs are stable and can withstand surgical strikes,emergency liver resection and two-step treatment can be used,but the two-step treatment will have better short-term survival and long-term survival results.In addition,through univariate and multivariate analysis,AFP>400?g/L and microvascular invasion are independent predictors of postoperative survival and tumor recurrence in this study.