title: [Survival analysis of patients with spontaneous rupture of hepatocellular carcinoma].
abstract: OBJECTIVE
  To explore the prognostic factors influencing overall survival (OS) in patients with spontaneous rupture of hepatocellular carcinoma (HCC-SR).
  
  
  METHODS
  The medical records of 44 patients with HCC-SR treated in our department from January 1, 2005 to April 1 2011 were retrospectively reviewed. The clinical and prognostic data of 19 HCC-SR patients who received curative hepatectomy were compared with data of 137 HCC patients with no SR who were managed by curative hepatectomy during the same period. Type of HCC-SR was defined according to previously established criteria. The clinicopathological data were evaluated for possible associations with OS of HCC-SR by univariate analysis with the Kaplan-Meier method followed by multivariate analysis with the Cox proportional hazard model.
  
  
  RESULTS
  While some clinical features differed between the HCC-SR patients and non-HCC-SR patients, the postoperative prognosis was comparable between the two groups: (1) The 1-, 2-, 3- and 5-year postoperative cumulative recurrence rates were 78.9% (15/19), 89.5% (17/19), 94.7% (18/19) and 94.7% (18/19) in the HCC-SR group but 43.1% (59/137), 54.0% (74/137), 59.1% (81/137) and 66.4% (91/137) in the non-HCC-SR group respectively, and the differences reached statistical significance (P = 0.006, 0.003, 0.002, and 0.014); (2) The 1-, 2-, 3- and 5-year postoperative disease-free survival rates were 10.5% (2/19), 5.3% (1/19), 5.3% (1/19) and 5.3% (1/19) in the HCC-SR group but 40.1% (55/137), 21.2% (29/137), 12.4% (17/137) and 4.4% (6/137) in the non-HCC-SR group respectively, and only the 1-year disease-free survival rate was significantly different (P = 0.032); (3) The 1-, 2-, 3- and 5-year postoperative OS rates were 42.1% (8/19), 10.5% (2/19), 5.3% (1/19) and 5.3% (1/19) in the HCC-SR group but 59.1% (81/137), 32.8% (45/137), 19.0% (26/137) and 6.6% (9/137) in the non-HCC-SR group, and none of the differences reached statistical significance (P = 1.972, 0.061, 0.200, 1.000). Multivariate analysis identified that severity of concomitant liver cirrhosis, levels of alpha fetoprotein (AFP), choice of treatment modality, and type of HCC-SR acted as factors influencing OS.
  
  
  CONCLUSIONS
  Patients with HCC-SR receiving curative hepatectomy have higher postoperative recurrence rates than their non-HCC-SR counterparts, but the two groups have similar postoperative OS rates. OS is influenced by severity of concomitant liver cirrhosis, level of AFP, choice of treatment modality, and type of HCC-SR.
authors.affiliation: Institute of Hepatobiliary-pancreatic-intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
authors.forename: Guo-gang
authors.initials: GG
authors.lastname: Zhao
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Yun-hong
authors.initials: YH
authors.lastname: Tian
authors.forename: De-xin
authors.initials: DX
authors.lastname: Li
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012422:Rupture, Spontaneous; D015996:Survival Rate