Timing of spontaneous hepatocellular carcinoma rupture as a prognostic indicator

The prognostic value of spontaneous ruptured hepatocellular carcinoma (rHCC) and its interaction with Barcelona Clinic Liver Cancer (BCLC) stages remain unclear. To assess the prognostic effects of rHCC and its interaction with BCLC staging. This was a retrospective cohort study enrolled 2,577 patients with hepatocellular carcinoma. rHCC was diagnosed using computed tomographic evidence of capsular disruption with extravasation of blood and classified as early or late according to whether rupture occurred ≤ 7 days or > 7 days after HCC diagnosis, respectively. Propensity score matching (PSM) was used to adjust for confounders. Cox proportional hazards regression models and Kaplan-Meier survival analyses were used to assess the prognostic effects of rHCC across BCLC stages. Of 2,577 patients, 102 (4.0%) had rHCC. Patients with rHCC were younger and had higher BCLC stages, worse liver function, and higher α-fetoprotein levels than those without rHCC. Multivariable Cox regression analysis revealed that late rHCC was a predictor of worse overall survival (OS; hazard ratio [HR]: 1.578, 95% confidence interval [CI]: 1.059-2.351) and that early rHCC was a protective factor (HR: 0.717, 95% CI: 0.519-0.992). A combination of early and late rupture did not predict OS. Kaplan-Meier analysis after PSM revealed that the OS for patients with early rHCC at BCLC stage B or C was similar to that for patients without rHCC (P = .594 for stage B and P = .566 for stage C) and that OS for patients with late rHCC at BCLC stage B or C was significantly worse than that for patients without rHCC (P = .007 for stage B and P = .006 for stage C). Late rHCC is associated with worse outcomes than early rHCC or nonruptured HCC at BCLC stages B and C.