Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2015; 21(24): 7488-7494
Published online Jun 28, 2015. doi: 10.3748/wjg.v21.i24.7488
Prognostic factors of spontaneously ruptured hepatocellular carcinoma
Xiang-Jun Han, Hong-Ying Su, Hai-Bo Shao, Ke Xu
Xiang-Jun Han, Hong-Ying Su, Hai-Bo Shao, Ke Xu, Department of Radiology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Xu K and Su HY designed the research. Shao HB and Han XJ collected and analyzed the data; Han XJ wrote the paper; all authors read and approved the final manuscript.
Supported by National High-tech Research Foundation of China, No. 2012AA022701.
Ethics approval: This study was approved by the Research Ethics Committee of the First Hospital of China Medical University (Number: 2013-112-2).
Informed consent: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest: The authors declare that they have no conflicts of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ke Xu, PhD, Department of Radiology, the First Hospital of China Medical University, No.155 North Nanjing Street, Heping District, Shenyang, Liaoning 110001, Liaoning Province, China. xuke1954@sina.com
Telephone: +86-24-83283368 Fax: +86-24-83283368
Received: December 9, 2014
Peer-review started: December 11, 2014
First decision: January 8, 2015
Revised: January 29, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: June 28, 2015
Abstract

AIM: To evaluate the prognostic factors in patients with spontaneously ruptured hepatocellular carcinoma (HCC).

METHODS: Seventy-nine patients experiencing spontaneous rupture of HCC between April 2004 and August 2014 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. The statistical methods used in this work included univariate analysis, Kaplan-Meier survival analysis with log-rank tests, and multivariate analysis using a Cox regression hazard model.

RESULTS: Of the 79 patients with HCC rupture, 17 (21.5%) underwent surgery, 32 (40.5%) underwent transarterial embolization (TAE), and 30 (38%) received conservative treatment. The median survival time was 125 d, and the mortality rate at 30 d was 27.8%. Multivariate analysis revealed that lesion length (HR = 1.46, P < 0.001), lesion number (HR = 1.37, P = 0.042), treatment before tumor rupture (HR = 4.36, P = 0.019), alanine transaminase levels (HR = 1.0, P = 0.011), bicarbonate levels (HR = 1.18, P < 0.001), age (HR = 0.96, P = 0.026), anti-tumor therapy during the follow-up period (HR = 0.21, P = 0.008), and albumin levels (HR = 0.89, P = 0.010) were independent prognostic factors of survival after HCC rupture. The Barcelona-Clinic Liver Cancer (BCLC) stage was also an important prognostic factor; the median survival times for BCLC stages A, B and C were 251, 175 and 40 d, respectively (P < 0.001).

CONCLUSION: Anti-tumor therapy during the follow-up period, without a history of anti-tumor therapy prior to HCC rupture, small tumor length and number, and early BCLC stage are the most crucial predictors associated with satisfactory overall survival. Other factors play only a small role in overall survival.

Keywords: Hepatocellular carcinoma, Rupture, Prognosis, Surgery, Transarterial embolization

Core tip: The most important predictors of survival in patients with spontaneous rupture of hepatocellular carcinoma (HCC) are continuous anti-tumor therapies during the follow-up period, tumor length and number, Barcelona-Clinic Liver Cancer stage, and a history of anti-tumor therapies prior to HCC rupture. Therefore, the present study may provide useful information for doctors making judgments on the prognosis of spontaneously ruptured HCC.