Factors Predicting Survival in Ruptured Hepatocellular Carcinoma Treated with Surgical Resection

Background: Today, ruptured hepatocellular carcinoma (HCC) is a less frequently encountered problem globally due to availability of cancer surveillance protocols for the high-risk population. However, in Thailand, a number of patients do not enroll in screening programs, leading to high rates of ruptured complications. In fit-for-surgery and clinically stable patients, hepatectomy means long-term survival. This study aimed to identify predictive factors of survival in resected patients. Methods: A retrospective review of patients with ruptured HCC who underwent liver resection between January 2013 and December 2019 at Siriraj Hospital was performed. The clinical data and outcomes of patients were analyzed. Results: A total of forty-five patients with ruptured HCC underwent resection or 9.8% (45/460) of all operable HCC cases. There were 6 patients (14.3%) who suffered from postoperative liver failure and one patient (2.4%) died within 30 days. Overall survival (OS) and recurrence-free survival were 90%, 64%, 52% and 42.5%, 24%, 16% at 1, 3, and 5 years, respectively. The factors affecting OS were tumor size > 10 cm, vascular invasion, and positive resection margin. Conclusion: Ruptured HCC is treatable disease and surgical resection plays a major role in good outcomes in patients.

Prognostic Influence of Spontaneous Tumor Rupture in Patients With Hepatocellular Carcinoma After Hepatectomy: A Meta-Analysis of Observational Studies

Objective: This study aims to comprehensively analyze the influence of spontaneous tumor rupture on the prognosis of hepatocellular carcinoma patients following hepatic resection.Methods: We systematically searched four online electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, for eligible studies published from inception to March 2021. The main endpoints were overall survival (OS) and disease-free survival (DFS).Results: This meta-analysis included 21 observational articles with 57,241 cases. The results revealed that spontaneous tumor rupture was associated with worse OS (hazard ratio (HR), 1.65; 95% confidence interval (CI), 1.33–2.05) and DFS (HR, 1.42; 95% CI, 1.12–1.80) in resectable hepatocellular carcinoma patients. This phenomenon was observed in most subgroups, which were classified by recorded survival time, age, country, alpha-fetoprotein (AFP) concentration, liver cirrhosis, and microvascular invasion. However, in subgroups of macrovascular invasion positive, spontaneous tumor rupture was not a risk factor for OS (HR, 1.55; 95% CI, 0.99–2.42) and DFS (HR, 1.23; 95% CI, 0.91–1.65) in hepatocellular carcinoma patients after hepatectomy. For macrovascular invasion negative, compared with non-ruptured hepatocellular carcinoma patients, ruptured hepatocellular carcinoma patients exhibited worse prognosis for OS (HR, 1.55; 95% CI, 0.99–2.42) and DFS (HR, 1.23; 95% CI, 0.91–1.65) following hepatectomy.Conclusions: Spontaneous tumor rupture was a prognostic risk factor for hepatocellular carcinoma patients after hepatic resection. However, in macrovascular invasion patients, spontaneous tumor rupture was not a prognostic risk factor.