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

Abstract

Purpose Spontaneous rupture is a potentially serious complication of liver cancer. A risk score was developed and validated for predicting spontaneous rupture based on a retrospective study. Methods Multiple logistic regression analysis was used to study the relationship between clinical variables and spontaneous rupture. The independent rupture predictors were converted into a score based on the odds ratio. Predicted attributes of the developed scores were then verified using a dataset in 2019. Results The incidence of spontaneous rupture was 5.5% from 2002 to 2019. A 10-point score (α-FP of ≥400 µg/L, 1; protrusion from liver surface, 2; ascites, 3; tumor size of >5 cm, 4) was derived for prediction of rupture and area under the receiver-operating characteristic curve was 0.9 (95% confidence interval, 0.87–0.92). When applying a cutoff value of 5 points or more, the specificity was 0.87 and the sensitivity was 0.84. A validation cohort consisting of 202 hepatocellular carcinoma patients reproduces the predictive, identification, and calibration characteristics. The observed rate of spontaneous rupture according to risk stratification of the score was 0.6% for those with a score of 0–4, 21.6% for a score of 5–7, and 36.4% for a score of 8–10 in the validation cohort. Conclusion Here, based on routine clinical data, we determine the factors that affect prognosis and propose an effective tool for predicting spontaneous rupture, which may be useful in guiding priority treatment of high-risk patients or clinical routine preventive treatment.

Hepatocellular Carcinoma Rupture after Introducing Lenvatinib: An Autopsy Case Report

“…The case fatality rate due to tumor rupture is 25-75%, making it a serious complication in patients with HCC ( 8 ). A serum AFP level of ≥400 ng/mL, tumor protrusion from the liver surface, ascites, and tumor size of ≥5 cm are considered risk factors for HCC rupture ( 9 ). In our case, the risk of HCC rupture may have been high because of tumor protrusion from the liver surface and the large tumor size, regardless of lenvatinib treatment.…”

Comparison of post-resection survival between hepatocellular carcinoma patients in BCLC stage A or B who experience tumor rupture and patients in BCLC stage C who do not

“…Studies have found that even if ruptured HCC patients can be managed promptly in the event of a critical situation, their long-term prognosis is worse than that of non-ruptured HCC [ [8] , [9] , [10] ]. How such rupture occurs is poorly understood [ 11 ] and it is associated with extremely poor survival [ [12] , [13] , [14] ]. Given the complex etiology and clinical heterogeneity of HCC, accurate staging of patients using well-established systems such as the TNM system [ 15 ] and the more widely used Barcelona Clinic Liver Cancer (BCLC) system [ 16 ] is essential for guiding treatment decisions.…”

Nomogram for Estimation of Acute Liver Failure Risk in Spontaneous Ruptured Hepatocellular Carcinoma

“…This may also affect the occurrence of ALF. 29,31 Decreased platelet count and prolonged prothrombin time both increase the tendency for bleeding, suggesting that hemorrhage and ischemia-reperfusion injury still have a significant impact on liver function. The synthesis of prothrombin indirectly reflects the liver's reserve function.…”