Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Cancer Med. 2024 May;13(10):e6952. doi: 10.1002/cam4.6952.
The Barcelona Clinic Liver Cancer (BCLC) staging system is an internationally recognized clinical staging system for hepatocellular carcinoma (HCC). However, this staging system does not address the staging and surgical treatment strategies for patients with spontaneous rupture hemorrhage in HCC. In this study, we aimed to investigate the prognosis of patients with BCLC stage A undergoing liver resection for HCC with spontaneous rupture hemorrhage and compare it with the prognosis of patients with BCLC stage A undergoing liver resection without rupture.
Clinical data of 99 patients with HCC who underwent curative liver resection surgery were rigorously followed up and treated at Shandong Provincial Hospital from January 2013 to January 2023. A retrospective cohort study design was used to determine whether the presence of ruptured HCC (rHCC) is a risk factor for recurrence and survival after curative liver resection for HCC. Prognostic comparisons were made between patients with ruptured and non-ruptured BCLC stage A HCC (rHCC and nrHCC, respectively) who underwent curative liver resection.
rHCC (hazard ratio [HR] = 2.974, [p] = 0.016) and tumor diameter greater than 5 cm (HR = 2.819, p = 0.022) were identified as independent risk factors for overall survival (OS) after curative resection of BCLC stage A HCC. The postoperative OS of the spontaneous rupture in the HCC group (Group I) was shorter than that in the BCLC stage A group (Group II) (p = 0.008). Tumor invasion without penetration of the capsule was determined to be an independent risk factor for recurrence-free survival (RFS) after liver resection for HCC (HR = 2.584, p = 0.002).
HCC with concurrent spontaneous rupture hemorrhage is an independent risk factor for postoperative OS after liver resection. The BCLC stage A1 should be added to complement the current BCLC staging system to provide further guidance for the treatment of patients with spontaneous rupture of HCC.
巴塞罗那临床肝癌（BCLC）分期系统是国际上公认的肝细胞癌（HCC）临床分期系统。然而，该分期系统并未涉及 HCC 自发性破裂出血患者的分期和手术治疗策略。本研究旨在探讨 BCLC A 期接受肝切除术治疗 HCC 合并自发性破裂出血患者的预后，并与 BCLC A 期未破裂患者的预后进行比较。
对 2013 年 1 月至 2023 年 1 月在山东省立医院接受根治性肝切除术治疗的 99 例 HCC 患者的临床资料进行了严格随访和治疗。采用回顾性队列研究设计，确定 HCC 破裂（rHCC）是否是 HCC 根治性切除术后复发和生存的危险因素。比较了接受根治性肝切除术治疗的破裂和未破裂 BCLC A 期 HCC 患者（rHCC 和 nrHCC）的预后。
rHCC（风险比[HR] = 2.974，[p] = 0.016）和肿瘤直径大于 5cm（HR = 2.819，p = 0.022）是 BCLC A 期 HCC 根治性切除术后总生存（OS）的独立危险因素。HCC 自发破裂组（I 组）的术后 OS 短于 BCLC A 期组（II 组）（p = 0.008）。肿瘤无包膜侵犯浸润被确定为 HCC 肝切除术后无复发生存（RFS）的独立危险因素（HR = 2.584，p = 0.002）。
HCC 合并自发性破裂出血是肝切除术后 OS 的独立危险因素。BCLC A1 期应补充到现行 BCLC 分期系统中，为自发性破裂 HCC 患者的治疗提供进一步指导。
