title: Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: a case-control study.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: 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.
authors.forename: Liang
authors.initials: L
authors.lastname: Huang
authors.affiliation: 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.
authors.forename: Cai-Feng
authors.initials: CF
authors.lastname: Liu
authors.affiliation: 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.
authors.forename: Jie
authors.initials: J
authors.lastname: Cao
authors.affiliation: 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.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Yan
authors.affiliation: 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.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: 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.
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
authors.affiliation: 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.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Yan
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; Risk factor; Rupture; Surgical outcome; Tumor location
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