Prognosis of spontaneously ruptured hepatocellular carcinoma: a propensity score matching study

• Published in: Journal of cancer research and clinical oncology Vol. 149; no. 11; pp. 8889 - 8896
• Main Authors: Zhang, Shi-Yu, Guo, De-Zhen, Zhang, Xin, Fan, Jia, Zhou, Jian, Huang, Ao
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2023; Springer Nature B.V
• Subjects: Cancer Research; Carcinoma, Hepatocellular - pathology; Hematology; Hepatectomy; Hepatocellular carcinoma; Humans; Internal Medicine; Liver cancer; Liver Neoplasms - pathology; Medical prognosis; Medicine; Medicine & Public Health; Oncology; Prognosis; Propensity Score; Retrospective Studies; Risk factors; Rupture; Rupture, Spontaneous - etiology; Rupture, Spontaneous - surgery; Survival; Treatment Outcome; Hepatocellular carcinoma; Survival; Spontaneous rupture; Classification; Hepatectomy
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-023-04774-3

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.