Department of Hepatobiliary Surgery, Jingmen First People's Hospital, 67 Xiangshan Avenue, Jingmen 448000, Hubei Province, China.
World J Gastroenterol. 2012 Dec 28;18(48):7302-7. doi: 10.3748/wjg.v18.i48.7302.
To determine the risk factors for hepatocellular carcinoma (HCC) rupture, and report the management and long-term survival results of patients with spontaneous rupture of HCC.
Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006, 200 (4.8%) patients with ruptured HCC (case group) were studied retrospectively in term of their clinical characteristics and prognostic factors. The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment, transarterial embolization (TACE) or hepatic resection. Results of various treatments in the case group were evaluated and compared with the control group (202 patients) without ruptured HCC during the same study period. Continuous data were expressed as mean ± SD or median (range) where appropriate and compared using the unpaired t test. Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate. The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test.
Compared with the control group, more patients in the case group had underlying diseases of hypertension (7.5% vs 3.0%, P =0.041) and liver cirrhosis (87.5% vs 56.4%, P < 0.001), tumor size >5 cm (83.0% vs 57.4%, P < 0.001), tumor protrusion from the liver surface (66.0% vs 44.6%, P < 0.001), vascular thrombus (30.5% vs 8.9%, P < 0.001) and extrahepatic invasion (36.5% vs 12.4%, P < 0.001). On multivariate logistic regression analysis, underlying diseases of hypertension (P = 0.002) and liver cirrhosis (P < 0.001), tumor size > 5 cm (P < 0.001), vascular thrombus (P = 0.002) and extrahepatic invasion (P < 0.001) were predictive for spontaneous rupture of HCC. Among the 200 patients with spontaneous rupture of HCC, 105 patients underwent hepatic resection, 33 received TACE, and 62 were managed with conservative treatment. The median survival time (MST) of all patients with spontaneous rupture of HCC was 6 mo (range, 1-72 mo), and the overall survival at 1, 3 and 5 years were 32.5%, 10% and 4%, respectively. The MST was 12 mo (range, 1-72 mo) in the surgical group, 4 mo (range, 1-30 mo) in the TACE group and 1 mo (range, 1-19 mo) in the conservative group. Ninety-eight patients in the control group underwent hepatic resection, and the MST and median disease-free survival time were 46 mo (range, 6-93 mo) and 23 mo (range, 3-39 mo) respectively, which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection (P < 0.001). The 1-, 3-, and 5-year overall survival rates and the 1-, 3- and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%, 19.0% and 7.6%, 27.6%, 14.3% and 3.8%, respectively, compared with those of 77.1%, 59.8% and 41.2%, 57.1%, 40.6% and 32.9% in 98 patients without ruptured HCC undergoing hepatectomy (P < 0.001).
Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy, although the survival results were inferior to those of the patients without ruptured HCC.
确定肝细胞癌（HCC）破裂的风险因素，并报告自发性 HCC 破裂患者的治疗和长期生存结果。
在 2002 年 4 月至 2006 年 11 月期间，东方肝胆外科医院诊断出 4209 例 HCC 患者，其中 200 例（4.8%）为破裂性 HCC（病例组），回顾性研究其临床特征和预后因素。破裂性 HCC 的一期治疗方法包括保守治疗、经动脉栓塞（TACE）或肝切除术。评估并比较了病例组与同期无破裂 HCC 的对照组（202 例）的各种治疗方法的结果。连续数据以平均值±标准差或中位数（范围）表示，使用未配对 t 检验进行比较。分类变量使用卡方检验（Yates 校正）或 Fisher 确切检验进行比较，适当时使用。使用 Kaplan-Meier 方法和对数秩检验确定每组的总生存率。
与对照组相比，病例组更多的患者患有高血压（7.5% vs. 3.0%，P=0.041）和肝硬化（87.5% vs. 56.4%，P<0.001），肿瘤直径>5cm（83.0% vs. 57.4%，P<0.001），肿瘤从肝表面突出（66.0% vs. 44.6%，P<0.001），血管血栓形成（30.5% vs. 8.9%，P<0.001）和肝外侵犯（36.5% vs. 12.4%，P<0.001）。多变量逻辑回归分析显示，高血压（P=0.002）和肝硬化（P<0.001）、肿瘤直径>5cm（P<0.001）、血管血栓形成（P=0.002）和肝外侵犯（P<0.001）是自发性 HCC 破裂的预测因素。在 200 例自发性 HCC 破裂的患者中，105 例行肝切除术，33 例行 TACE，62 例行保守治疗。所有自发性 HCC 破裂患者的中位生存时间（MST）为 6 个月（范围 1-72 个月），1、3 和 5 年总生存率分别为 32.5%、10%和 4%。手术组的 MST 为 12 个月（范围 1-72 个月），TACE 组为 4 个月（范围 1-30 个月），保守组为 1 个月（范围 1-19 个月）。对照组中有 98 例患者行肝切除术，MST 和中位无病生存时间分别为 46 个月（范围 6-93 个月）和 23 个月（范围 3-39 个月），明显长于行肝切除术的 HCC 破裂患者（P<0.001）。破裂性 HCC 行肝切除术患者的 1、3 和 5 年总生存率和 1、3 和 5 年无病生存率分别为 57.1%、19.0%和 7.6%、27.6%、14.3%和 3.8%，而 98 例无破裂性 HCC 行肝切除术患者的 1、3 和 5 年总生存率和 1、3 和 5 年无病生存率分别为 77.1%、59.8%和 41.2%、57.1%、40.6%和 32.9%（P<0.001）。
虽然生存结果不如无破裂 HCC 患者，但在选择的患者中进行一期肝切除术可以获得延长的生存。
