Tanaka Shogo, Kaibori Masaki, Ueno Masaki, Wada Hiroshi, Hirokawa Fumitoshi, Nakai Takuya, Iida Hiroya, Eguchi Hidetoshi, Hayashi Michihiro, Kubo Shoji
Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
J Gastrointest Surg. 2016 Dec;20(12):2021-2034. doi: 10.1007/s11605-016-3280-2. Epub 2016 Oct 7.
While spontaneously ruptured hepatocellular carcinoma (HCC) has a poor prognosis, the true impact of a rupture on survival after hepatic resection is unclear.
Fifty-eight patients with ruptured HCC and 1922 with non-ruptured HCC underwent hepatic resection between 2000 and 2013. To correct the difference in the clinicopathological factors between the two groups, propensity score matching (PSM) was used at a 1:1 ratio, resulting in a comparison of 42 patients/group. We investigated outcomes in all patients with ruptured HCC and compared outcomes between the two matched groups.
Of the 58 patients with ruptured HCC, 7 patients (13 %) died postoperatively. Overall survival (OS) rate at 5 years after hepatic resection was 37 %. Emergency hepatic resection was an independent risk factor for in-hospital death and Child-Pugh class B for unfavorable OS in multivariate analysis. Clinicopathological variables were well-balanced between the two groups after PSM. No significant differences were noted in incidence of in-hospital death (ruptured HCC 12 % vs non-ruptured HCC 2 %, p = 0.202) or OS rate (5/10-year; 42 %/38 % vs 67 %/30 %, p = 0.115).
Emergency hepatic resection should be avoided for ruptured HCC in Child-Pugh class B patients. Rupture itself was not a risk for unfavorable surgical outcomes.
虽然自发性破裂的肝细胞癌（HCC）预后较差，但破裂对肝切除术后生存的真正影响尚不清楚。
2000年至2013年间，58例破裂性HCC患者和1922例非破裂性HCC患者接受了肝切除术。为校正两组之间临床病理因素的差异，采用倾向评分匹配（PSM），按1:1的比例进行匹配，最终每组比较42例患者。我们调查了所有破裂性HCC患者的预后情况，并比较了两组匹配患者的预后。
58例破裂性HCC患者中，7例（13%）术后死亡。肝切除术后5年总生存率（OS）为37%。在多因素分析中，急诊肝切除术是院内死亡的独立危险因素，Child-Pugh B级是OS不良的危险因素。PSM后两组间临床病理变量均衡。院内死亡率（破裂性HCC为12%，非破裂性HCC为2%，p = 0.202）或OS率（5/10年；42%/38%对67%/30%，p = 0.115）无显著差异。
Child-Pugh B级的破裂性HCC患者应避免急诊肝切除术。破裂本身并非手术预后不良的危险因素。
