The Efficacy Of Hyperthermic Intraperitoneal Chemotherapy In The Treatment Of Spontaneously Ruptured Hepatocellular Carcinoma And The Prognosis Of Patients With Hepatocellular Carcinoma Concomitantly Suffer From Cirrhosis

Background:Spontaneous tumor rupture of hepatocellular carcinoma(HCC)is a life-threatening complication of HCC,which is also one of the direct causes of the final death of HCC patients.It is characterized by sudden onset and rapid progress.Hepatectomy is an effective treatment for srHCC.It can stop bleeding and remove the primary tumor at the same time.Intraperitoneal hyperthermic perfusion chemotherapy(HIPEC)has been widely used in the treatment of a variety of solid abdominal tumors,but the application of HIPEC in srHCC is debatable.The aim of our study was to compare the outcomes of srHCC VS.nrHCC with propensity score matching(PSM)method and to evaluate the role of HIPEC after hepatectomy in patients with srHCC.Methods:From 2014 to 2018 in Guangdong Provincial People’s hospital,PSM was performed comparing 57 patients who underwent liver resection(LR)for srHCC which met the study criteria were included with 57 nrHCC patient selected from a cohort of 446 patients during the study period.Then patients with srHCC were divided into two group according to whether undergoing HIPEC after hepatectomy for further analysis.Results:After 1:1 PSM analysis,the clinical characteristics of srHCC and nrHCC were comparable.In terms of long term outcomes,the nrHCC group has significant longer OS(P=0.026)and DFS(P<0.001).Of the 57 srHCC patients,HIPEC group showed additional complications,increasing length of hospital stay and in-hospital cost.However,it has no significant statistical differrence in metastatic patterns in these recurrent patients and there was no statistically significant difference for DFS(P=0.28)and OS(P=0.56)between two groups.Conclusions:The outcome for ruptured HCC patients was poor compared with that for non-ruptured HCC patients.There is no sufficient evidence to prove whether postoperative HIPEC can effectively improve the prognosis of patients.Background:Patients with hepatocellular carcinoma(HCC)concomitantly suffer from liver cirrhosis may have worse prognosis.Based on Surveillance,Epidemiology,and End Results(SEER)database,we evaluated the overall survival(OS)and cancer-specific survival(CSS)of these patients.We aimed to construct and validate a simple,practical and effective nomogram model to evaluate the survival rate of patients.Methods:A total of 2,369 patients were selected from the SEER database.They were classified into F0(n=691)and F1(n=1,678)groups by different Ishak fibrosis score.Propensity score matching(PSM)and Kaplan-Meier method were performed to evaluate the OS and CSS.The F1 group were randomized into training sub-set(n=1,176,70%)and validation sub-set(n=502,30%)for further construction and validation of nomogram.Results:After matched,there were statistically significant worse outcome for F1 group patients compared with F0 group(n=587,OS:P<0.001,CSS:P<0.001).Six independent predictors for both OS and CSS were identified to construct the nomograms by COX regression analyses.The nomogram performed well concerning its ability of discrimination and calibration and its net benefits compared with the conventional staging system.Conclusions:Patients with HCC concomitantly suffer from severe fibrosis or cirrhosis has a significant worse survival compared with none or moderate fibrosis patients.The validated nomograms provided useful prediction of survival.