Sada Haruki, Ohira Masahiro, Kobayashi Tsuyoshi, Tashiro Hirotaka, Chayama Kazuaki, Ohdan Hideki
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Dig Surg. 2016;33(1):43-50. doi: 10.1159/000441531. Epub 2015 Nov 19.
BACKGROUND/AIMS: The prognosis of spontaneous rupture of hepatocellular carcinoma (HCC) remains unclear. We investigated the prognosis of patients with ruptured HCC based on the treatments and prognostic factors associated with long-term survival.
The prognoses of 64 consecutive patients treated for ruptured HCC from 1986 to 2013 were analyzed according to their methods of treatment. The prognostic factors of 16 surgical patients were identified, and their overall survival (OS) and recurrence rates were compared to 1,157 surgical patients who underwent surgery for non-ruptured HCC. The surgical outcomes were also compared using a propensity score matching method.
Surgery was associated with a better OS. Curative resection was the only independent prognostic factor in surgical patients with ruptured HCC (p = 0.040). Although the OS of surgical patients with non-ruptured HCC was found to be significantly better than that of the patients with ruptured HCC, no significant difference in OS was observed after propensity score matching.
A curative resection should be the objective of treatment, assuming the suitability of the patient's clinical condition. When the liver function reserve and tumor extension of patients with ruptured and non-ruptured HCC are similar, then their surgical outcomes may not be significantly different.
背景/目的：肝细胞癌（HCC）自发性破裂的预后仍不明确。我们基于治疗方法及与长期生存相关的预后因素，对破裂性HCC患者的预后进行了研究。
分析了1986年至2013年间连续接受治疗的64例破裂性HCC患者的预后情况，并根据其治疗方法进行分类。确定了16例手术患者的预后因素，并将其总生存期（OS）和复发率与1157例接受非破裂性HCC手术的患者进行比较。还采用倾向评分匹配法比较了手术结果。
手术与更好的总生存期相关。根治性切除是破裂性HCC手术患者唯一的独立预后因素（p = 0.040）。尽管发现非破裂性HCC手术患者的总生存期明显优于破裂性HCC患者，但倾向评分匹配后总生存期无显著差异。
假设患者临床状况适宜，根治性切除应作为治疗目标。当破裂性和非破裂性HCC患者的肝功能储备和肿瘤范围相似时，其手术结果可能无显著差异。
