Conditional survival in patients with spontaneous tumor rupture of hepatocellular carcinoma after partial hepatectomy: a propensity score matching analysis

Abstract

Background: Spontaneous tumor rupture (STR) of hepatocellular carcinoma (HCC) is a life-threatening condition. This study investigates the influences of STR on the observed survival and conditional survival of patients received hepatectomy.Methods: A retrospective cohort of patients who underwent hepatectomy from 2009 to 2013 was divided into tumor rupture group and non-rupture group. Propensity score matching (PSM) was used for comparison of the observed survival and conditional survival probabilities between these two groups.Results: 89 pairs of patients who had comparable background and tumor characteristics were created using PSM analysis. There was significant association between STR and increased risk of OS no matter when before or after PSM (p < 0.01). STR was significantly associated with increased risks of PFS before, while not after PSM. Multivariate Cox regression analyses demonstrated that STR was an independent risk factor associated with OS. There were significant differences in two groups for conditional probabilities of OS and PFS for an additional 6 months and 1 year before PSM, while not after PSM. Conclusions: This study identified STR but not PFS as an independent risk factor influencing OS, in patients with HCC following hepatectomy. In selected patients with STRHCC, hepatectomy should be performed with acceptable outcomes.

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

“…After removing duplicates, 2,952 records remained. Twenty-one studies (13,18,19,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were ultimately included following a strict screening process. The comprehensive literature review and rigorous selection process are displayed in Figure 1.…”

Development and validation of risk score for predicting spontaneous rupture of hepatocellular carcinoma

“…Some other limitations of APAS score also need to be discussed. First, as a large proportion of the patients in our study population are HCC cases related to hepatitis B, it is necessary to carry out external validation research on the general application of APAS score in Western populations in the future [ 1 4 ]. Second, the diagnosis of PFLS was reviewed independently by 2 radiologists and no standardized criteria were applied.…”

“…Spontaneous liver rupture is a potentially serious complication of liver cancer and occurs in about 3%–26% of hepatocellular carcinoma (HCC) patients [ 1 ]. Mortality from spontaneously ruptured HCC (rHCC) remains high in the acute phase, ranging from 25% to 75%, and the median survival is short, about 7–21 weeks, making it the third common cause of death of liver cancer excepting cancer progression and liver failure [ 2 3 ].…”

Multimodality Management of Ruptured Large Hepatocellular Carcinoma and Its Recurrence: Rupture at Presentation Should Not Rupture Hope of Long-Term Survival

“…As shown in ►Table 1, other case-control and cohort studies also show that in cases with tumor rupture, staged hepatectomy gives a better outcome in terms of overall survival (OS), though the recurrence-free survival (RFS) is adversely affected by tumor rupture. [8][9][10][11][12][13][14][15] As we can see, TAE has been used by many studies for stabilization followed by elective surgery and this plan gives a better 5-year OS and RFS. Thus, the studies do point toward a good outcome in operable patients of ruptured HCC by this strategy.…”