title: Outcomes of patients with spontaneous rupture of hepatocellular carcinoma.
abstract: OBJECTIVE
  The prognosis of ruptured hepatocellular carcinoma (HCC) has been reported to be poor, but some studies have reported better survival with staged hepatectomy. The aim of this study was to elucidate the clinical features of ruptured HCC.
  
  
  METHODS
  Among 305 patients with HCC who underwent hepatic resection between 1990 and 2008 in our institution, 10 patients had ruptured HCC. Ruptured group (Group R; n=10)were compared with those of patients with unruptured HCC group (Group UR; n=295), concerning hepatic reserve, tumor extent and outcome.
  
  
  RESULTS
  Rupturedgroup had extremely large tumor than unruptured group (94 + 43 mm vs. 45 +/- 32 mm, p < 0.001). The proportions of multiple nodules and poorly tumor grade were significantly higher in Group R than in Group UR. The populations of extrahepatic recurrence and early mortality (<1 year) were significant higher in Group R than Group NR. The median survival time of Group R was shorter than Group NR. The tumor rupture was independent prognostic factors that had the most serious effect on the survival of patients with HCC among the patients with HCC underwent hepatic resection.
  
  
  CONCLUSIONS
  The patients with spontaneously ruptured HCC had advanced disease, and poor prognosis. Hepatic resection might improve the survival, but a new therapeutic strategy is necessary for the long-term survival of patients with ruptured HCC.
authors.affiliation: Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima Saga, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyoshi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kitahara
authors.forename: Naohiko
authors.initials: N
authors.lastname: Kohya
authors.forename: Hirohazu
authors.initials: H
authors.lastname: Noshiro
authors.forename: Kohji
authors.initials: K
authors.lastname: Miyazahi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012422:Rupture, Spontaneous; D015996:Survival Rate; D016896:Treatment Outcome