Spontaneous tumor rupture and surgical prognosis of patients with hepatocellular carcinoma.
BACKGROUND
Spontaneous rupture is an uncommon but the most fatal complication of hepatocellular carcinoma (HCC) and is recognized as a risk factor for tumor recurrence. The present study is to investigate the short- and long-term survival of the patients with HCC rupture and evaluate the influence of tumor rupture on patient's survival after hepatic resection.


METHODS
The clinical data of 101 patients with HCC rupture from 2000 to 2010 were reviewed retrospectively. The management of tumor rupture and clinicopathological parameters affecting 30-day mortality of the patients were recorded and evaluated. Long-term survival of the 41 patients undergoing hepatic resection was compared with 446 patients with non-ruptured HCC at the same time period.


RESULTS
The 30-day mortality rate of the 101 patients with HCC rupture was 35.6% and median survival was 79 days. The independent risk factors affecting 30-day mortality were tumor size and blood transfusion quantity. Compared with 446 non-ruptured HCC patients, 41 patients with ruptured HCC undergoing hepatic resection had a similar overall and disease-free survival to 446 without rupture (Log-rank test, p = 0.704 and 0.084, respectively). Multivariate analysis revealed that age, gender, and tumor size were independently significant factors in differentiating tumor rupture from non-rupture.


CONCLUSIONS
Early mortality of spontaneous rupture of HCC was dependent on preoperational liver function, tumor status, and severity of bleeding. Prolonged survival can be achieved in patients with ruptured HCC after hepatic resection as those without the complication.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
Xu-Feng
XF
Zhang
Tao
T
Wei
Xue-Min
XM
Liu
Yi
Y
Lv
D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018572:Disease-Free Survival; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000150:complications / Q000601:surgery; D012737:Sex Factors; D013997:Time Factors; D047368:Tumor Burden
D000970:Antineoplastic Agents