Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
Duke-National University of Singapore (NUS) Medical School, Singapore.
Eur J Surg Oncol. 2019 Sep;45(9):1652-1659. doi: 10.1016/j.ejso.2019.03.044. Epub 2019 Apr 9.
Spontaneous rupture of HCC (srHCC) is a life-threatening sequela of HCC characterized by a high mortality. Liver resection (LR) is the ideal therapeutic strategy as it not only arrests hemorrhage but also remove the offending tumour. We sought to determine the impact of spontaneous rupture on the survival outcomes of patients after LR by performing a propensity score matched (PSM) analysis comparing patients who underwent LR for srHCC versus non-ruptured (nrHCC).
From 2000 to 2015, a total of 67 patients who underwent LR for srHCC which met the study criteria were included. 1:2 PSM was performed comparing 49 of 67 patients with srHCC with 98 nrHCC selected from a cohort of 724 patients who underwent LR during the study period.
Median survival following LR for srHCC was 21.9 months, while 5-year overall survival (OS) and disease-free survival (DFS) was 43.1% and 19.4% respectively. After 1:2 PSM analysis, there was no significant difference between LR for srHCC (n = 49) versus nrHCC (n-98) in terms of OS [21.9 (interquartile range (IQR), 11.8-44.0 vs 27.4 (IQR, 6.9-57.8) months, HR 1.02, CI 0.63-1.66, p = 0.94], DFS [11.8 (IQR, 5.6-25.6) vs 13.77 (IQR,4.5-34.9) HR 0.74, CI 0.54-1.02, p = 0.06] and length of stay [8 (IQR, 7-11) vs 7 (IQR, 6-10) HR 0.93, CI 0.0.68-1.29), p = 0.68].
LR for clinically stable patients with srHCC provides survival and recurrence outcomes that are comparable to patients with nrHCC.
肝细胞癌（HCC）自发破裂是 HCC 的一种危及生命的并发症，其死亡率很高。肝切除术（LR）是理想的治疗策略，因为它不仅可以止血，还可以切除致病肿瘤。我们通过对接受 LR 治疗 HCC 自发破裂（srHCC）与非破裂（nrHCC）患者进行倾向评分匹配（PSM）分析，旨在确定自发破裂对 LR 后患者生存结局的影响。
2000 年至 2015 年，共纳入 67 例符合研究标准的接受 LR 治疗 srHCC 的患者。对 67 例 srHCC 患者中的 49 例进行 1:2 PSM，与研究期间接受 LR 的 724 例患者中选择的 98 例 nrHCC 进行比较。
接受 srHCC LR 后中位生存时间为 21.9 个月，5 年总生存率（OS）和无病生存率（DFS）分别为 43.1%和 19.4%。经过 1:2 PSM 分析，LR 治疗 srHCC（n=49）与 nrHCC（n=98）在 OS[21.9（IQR，11.8-44.0 与 27.4（IQR，6.9-57.8）个月，HR 1.02，CI 0.63-1.66，p=0.94]、DFS[11.8（IQR，5.6-25.6）与 13.77（IQR，4.5-34.9）HR 0.74，CI 0.54-1.02，p=0.06]和住院时间[8（IQR，7-11）与 7（IQR，6-10）HR 0.93，CI 0.0.68-1.29，p=0.68]方面无显著差异。
对于临床稳定的 srHCC 患者，LR 提供的生存和复发结果与 nrHCC 患者相当。
