Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, South Korea.
World J Gastroenterol. 2013 Jul 28;19(28):4537-44. doi: 10.3748/wjg.v19.i28.4537.
To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC).
A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm(3)/mL in bloody fluid.
Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4- and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with post-treatment mortality.
Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE.
评估因自发性肝细胞癌（HCC）破裂而行手术、经动脉栓塞（TAE）或支持性治疗的患者的临床结局。
回顾性纳入 2003 年至 2012 年期间在我院诊断为自发性 HCC 破裂的连续 54 例患者。HCC 的诊断基于 2005 年美国肝病研究协会发布的诊断指南。HCC 破裂定义为动态肝脏计算机断层扫描显示肿瘤周围肝包膜破裂，HCC 周围肝区有增强的液体积聚，并且腹腔穿刺显示血性液中腹水红细胞计数>50000/mm(3)/mL。
54 例患者中，6 例（11.1%）行手术治疗，25 例（46.3%）行 TAE，23 例（42.6%）行支持性治疗。手术或 TAE 组患者的 2、4 和 6 个月累积生存率分别为 60%、60%和 60%，显著高于支持性治疗组的 8.7%、0%和 0%（均 P<0.01），且手术组患者的生存率高于 TAE 组。多因素分析显示，血清胆红素（HR=1.09，P<0.01）、肌酐（HR=1.46，P=0.04）和升压药需求（HR=2.37，P=0.02）与治疗后死亡率显著相关，而手术（HR=0.41，P<0.01）和 TAE（HR=0.13，P=0.01）与治疗后死亡率呈负相关。
与支持性治疗相比，手术或 TAE 治疗后的生存时间更长，手术治疗的生存获益似乎优于 TAE。
