Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China.
Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, OR, 97201, USA.
Hepatol Int. 2022 Dec;16(6):1330-1338. doi: 10.1007/s12072-022-10403-x. Epub 2022 Aug 25.
To investigate predictors affecting survival in patients with spontaneously ruptured hepatocellular carcinoma (srHCC).
One-hundred-and-twenty-seven patients experiencing srHCC between January 2010 and December 2020 were enrolled. The clinical features, treatments, and outcomes were reviewed. Statistics included univariate analysis, Kaplan-Meier analysis, multivariate analysis using Cox proportional hazards model and logistic regression model, and receiver operating characteristic (ROC) curve analysis.
Of the 127 srHCC patients, 24, 42, and 61 patients received conservative treatment, surgical treatment, and transarterial chemoembolization/embolization (TACE/TAE) treatment at HCC rupture, respectively. The largest tumor size [hazard ratio (HR) 1.127; p < 0.001], Barcelona-Clinic Liver Cancer (BCLC) stage (HR 2.184, p = 0.023), international normalized ratio (INR; HR 3.895; p = 0.012), total bilirubin level (TBil; HR 1.014; p = 0.014), TACE after rupture (compared with conservative treatment) (HR 0.549; p = 0.029), TACE/TAE and surgery at rupture, and albumin level (HR 0.949; p = 0.017) were independent predictors affecting overall survival. A survival predictive model for HCC rupture (SPHR) using these predictors was created. ROC analysis showed that the area under the curve (AUC) of the SPHR model for 30 day survival was 0.925, and the AUCs of the model for end-stage liver disease (MELD) score and Child-Pugh score for 30 day survival were 0.767 and 0.757, respectively.
The largest tumor size, advanced BCLC stage, higher INR and TBil, lower albumin, and conservative treatment were negative independent predictors for overall survival. The SPHR model may be more suitable than the MELD score and Child-Pugh score for predicting 30 day survival in srHCC.
探讨影响自发性肝癌破裂（srHCC）患者生存的预测因素。
回顾性分析 2010 年 1 月至 2020 年 12 月期间 127 例 srHCC 患者的临床特征、治疗方法和转归。统计分析包括单因素分析、Kaplan-Meier 分析、Cox 比例风险模型和 Logistic 回归模型多因素分析以及受试者工作特征（ROC）曲线分析。
127 例 srHCC 患者中，分别有 24、42 和 61 例患者在 HCC 破裂时接受保守治疗、手术治疗和经肝动脉化疗栓塞/栓塞（TACE/TAE）治疗。最大肿瘤直径[风险比（HR）1.127；p<0.001]、巴塞罗那临床肝癌（BCLC）分期（HR 2.184，p=0.023）、国际标准化比值（INR；HR 3.895；p=0.012）、总胆红素水平（TBil；HR 1.014；p=0.014）、破裂后 TACE（与保守治疗相比）（HR 0.549；p=0.029）、破裂时 TACE/TAE 和手术以及白蛋白水平（HR 0.949；p=0.017）是影响总生存的独立预测因素。使用这些预测因素建立了一个预测 HCC 破裂的生存预测模型（SPHR）。ROC 分析显示，该模型预测 30 天生存率的曲线下面积（AUC）为 0.925，模型预测 MELD 评分和 Child-Pugh 评分 30 天生存率的 AUC 分别为 0.767 和 0.757。
最大肿瘤直径、BCLC 晚期、较高的 INR 和 TBil、较低的白蛋白以及保守治疗是总生存的负独立预测因素。SPHR 模型可能比 MELD 评分和 Child-Pugh 评分更适合预测 srHCC 的 30 天生存率。
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