Case Control Study
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World J Gastroenterol. Jul 21, 2014; 20(27): 9121-9127
Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9121
Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study
Jing Li, Liang Huang, Cai-Feng Liu, Jie Cao, Jian-Jun Yan, Feng Xu, Meng-Chao Wu, Yi-Qun Yan
Jing Li, Liang Huang, Cai-Feng Liu, Jie Cao, Jian-Jun Yan, Feng Xu, Meng-Chao Wu, Yi-Qun Yan, Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Author contributions: Li J and Huang L performed the study; Liu CF, Cao J, Yan JJ and Xu F collected the clinicopathological data and were involved in editing the manuscript; Li J and Huang L wrote the manuscript; Wu MC and Yan YQ designed the study; Li J and Huang L contributed equally to this work.
Supported by Grants of National Science and Technology Major Project Foundation, No. 2008ZX10002-025; and Scientific Research Fund Projects of Shanghai Health Bureau, No. 2009Y066
Correspondence to: Yi-Qun Yan, Professor, Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 800 Yinxiang Road, Shanghai 200438, China. ehbhyyq@163.com
Telephone: +86-21-81875501 Fax: +86-21-65562400
Received: January 5, 2014
Revised: March 12, 2014
Accepted: April 15, 2014
Published online: July 21, 2014
Processing time: 196 Days and 20.1 Hours
Abstract

AIM: To investigate the risk factors and surgical outcomes for spontaneous rupture of Barcelona Clinic Liver Cancer (BCLC) stages A and B hepatocellular carcinoma (HCC).

METHODS: From April 2002 to November 2006, 92 consecutive patients with spontaneous rupture of BCLC stage A or B HCC undergoing hepatic resection were included in a case group. A control arm of 184 cases (1:2 ratio) was chosen by matching the age, sex, BCLC stage and time of admission among the 2904 consecutive patients with non-ruptured HCC undergoing hepatic resection. Histological confirmation of HCC was available for all patients and ruptured HCC was confirmed by focal discontinuity of the tumor with surrounding perihepatic hematoma observed intraoperatively. Patients with microvascular thrombus in the hepatic vein branches were excluded from the study. Clinical data and survival time were collected and analysed.

RESULTS: Sixteen patients were excluded from the study based on exclusion criteria, of whom 3 were in the case group and 13 in the control group. Compared with the control group, more patients in the case group had underlying diseases of hypertension (10.1% vs 3.5%, P = 0.030) and liver cirrhosis (82.0% vs 57.9%, P < 0.001). Tumors in 67 (75.3%) patients in the case group were located in segments II, III and VI, and the figure in the control group was also 67 (39.7%) (P < 0.001). On multivariate analysis, hypertension (HR = 7.38, 95%CI: 1.91-28.58, P = 0.004), liver cirrhosis (HR = 6.04, 95%CI: 2.83-12.88, P < 0.001) and tumor location in segments II, III and VI (HR = 5.03, 95%CI: 2.70-6.37, P < 0.001) were predictive for spontaneous rupture of HCC. In the case group, the median survival time and median disease-free survival time were 12 mo (range: 1-78 mo) and 4 mo (range: 0-78 mo), respectively. The 1-, 3- and 5-year overall survival rates and disease-free survival rates were 66.3%, 23.4% and 10.1%, and 57.0%, 16.8% and 4.5%, respectively. Only radical resection remained predictive for overall survival (HR = 0.32, 95%CI: 0.08-0.61, P = 0.015) and disease-free survival (HR = 0.12, 95%CI: 0.01-0.73, P = 0.002).

CONCLUSION: Tumor location, hypertension and liver cirrhosis are associated with spontaneous rupture of HCC. One-stage hepatectomy should be recommended to patients with BCLC stages A and B disease.

Keywords: Hepatocellular carcinoma; Rupture; Risk factor; Tumor location; Surgical outcome

Core tip: There are few reports concerning the risk factors associated with spontaneous rupture of hepatocellular carcinoma (HCC) and the best approach in cases of ruptured HCC. This retrospective case-control study showed that three predictive factors including hypertension, liver cirrhosis and tumor location in segments II, III and VI were associated with spontaneous rupture of HCC. Especially, the relationship between tumor location and spontaneous rupture of HCC was identified for the first time.