title: Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma: an analysis of 1160 cases from a nationwide survey.
abstract: OBJECTIVE
  The aim of the present study was to investigate the background characteriscs of ruptured hepatocellular carcinoma (HCC) and to clarify the true impact of tumor rupture on patient prognosis in a large patient cohort.
  
  
  BACKGROUND
  Spontaneous tumor rupture of HCC has been associated with a very poor patient prognosis and the current TNM staging systems classify ruptured HCC as T4 based on insufficient evidence.
  
  
  METHODS
  In total, 1106 patients with ruptured HCC were extracted from the database of a nationwide survey conducted in Japan from 2000 to 2005. The clinicopathological parameters associated with HCC rupture were investigated using univariate and multivariate logistic regression models. The survival curves for ruptured and nonruptured HCC were generated and compared to evaluate the impact of the event (rupture) itself on patient prognosis and the TNM staging systems.
  
  
  RESULTS
  The multivariate analyses showed that tumor rupture was associated with both a poor liver functional reserve and an advanced tumor status. Analyses of the survival curves stratified according to the baseline TNM staging showed that tumor rupture had an additional impact on the baseline survival curves without rupture, and the impact corresponded to the addition of 0.5 to 2 stages to the baseline tumor staging.
  
  
  CONCLUSIONS
  The present study suggested that tumor rupture itself had a negative impact on patient survival. However, its impact was not strong enough to cancel the effects of the other tumor-related parameters. Therefore, it may be appropriate to give additional stages to the baseline tumor staging in cases of ruptured HCC.
authors.affiliation: *Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan †Department of Biostatistics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ‡Department of Gastroenterology and Hepatology, Musashino Red-Cross Hospital, Musashino, Japan §Department of Hepatology and Gastroenterology, Juntendo Shizuoka Hospital, Izunokuni, Japan ¶Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka Sayama, Japan ‖Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan **Department of Pathology, Keio University School of Medicine, Tokyo, Japan ††Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan ‡‡Department of Radiology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan §§Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Namiki
authors.initials: N
authors.lastname: Izumi
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
authors.forename: Michiie
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Nakashima
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000453:epidemiology; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends