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Prognosis of spontaneously ruptured hepatocellular carcinoma: a propensity score matching study
Shi-Yu Zhang1,2,3, De-Zhen Guo1,2,3, Xin Zhang1,2,3
1Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China.
Insights
Spontaneous rupture of hepatocellular carcinoma (HCC) does not impact survival rates. Resected ruptured HCC patients can achieve survival comparable to non-ruptured cases.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Spontaneous rupture is a critical, often fatal, complication of hepatocellular carcinoma (HCC).
- Understanding the prognostic implications of spontaneous rupture is crucial for patient management and treatment strategies.
Purpose of the Study:
- To compare the prognosis of spontaneously ruptured HCC (srHCC) with that of non-ruptured HCC (nrHCC) in patients undergoing hepatectomy.
- To evaluate the impact of spontaneous rupture on overall survival (OS) and time to recurrence (TTR).
Main Methods:
- Retrospective review of 185 srHCC and 1085 nrHCC patients who underwent hepatectomy between February 2005 and December 2017.
- Propensity score matching (PSM) analysis (1:2 ratio) to minimize confounding factors.
- Evaluation of overall survival (OS) and time to recurrence (TTR) as primary endpoints.
Main Results:
- Before PSM, srHCC patients had significantly poorer 5-year OS (39.1% vs 59.2%) and higher 5-year TTR (83.8% vs 54.9%) compared to nrHCC.
- After PSM, srHCC patients showed a higher 5-year TTR (83.2% vs 69.0%) but comparable 5-year OS (44.0% vs 46.0%) to nrHCC.
- Spontaneous rupture was an independent risk factor for TTR (HR 1.681) but not for OS (HR 1.074).
Conclusions:
- Spontaneous rupture of HCC is not an independent risk factor for overall survival.
- Hepatectomy for srHCC can lead to survival outcomes comparable to those of nrHCC.
- Current staging systems may need re-evaluation regarding the classification of srHCC.
Purpose:
Spontaneous rupture is a fatal complication of hepatocellular carcinoma (HCC). This study compared the prognosis of spontaneously ruptured HCC (srHCC) with that of non-ruptured HCC (nrHCC).
Methods:
A total of 185 srHCC patients and 1085 nrHCC patients treated by hepatectomy between February 2005 and December 2017 at Zhongshan Hospital were retrospectively reviewed and enrolled. The overall survival (OS) and time to recurrence (TTR) were evaluated. A 1:2 propensity score matching (PSM) analysis was performed using the nearest neighbor matching with a caliper of 0.2.
Results:
Before PSM, patients with srHCC who underwent hepatectomy (n = 185) had a poorer prognosis than those with nrHCC (n = 1085; 5-year OS, 39.1% vs 59.2%, P < 0.001; 5-year TTR, 83.8% vs 54.9%, P < 0.001). After PSM, patients with srHCC (n = 156) had higher 5-year TTR (83.2% vs 69.0%, P < 0.001) but comparable 5-year OS with those with nrHCC (n = 312, 44.0% vs 46.0%, P = 0.600). Univariate and multivariate analyses demonstrated spontaneous rupture as an independent risk factor for TTR (hazard ratio [HR], 1.681; 95% confidence interval [CI] 1.326-2.132; P < 0.001), but not for OS (HR: 1.074; 95% CI 0.823-1.401; P = 0.600). Further analysis revealed that srHCC was not appropriate to be assigned as T4 stage in American Joint Committee on Cancer classification.
Conclusion:
Spontaneous rupture of HCC is not a risk factor for survival. If resected eventually, srHCC may achieve comparable survival with nrHCC.
