Early-Stage Ruptured Hepatocellular Carcinoma With Different Tumor Diameters: Small Tumors Have a Better Prognosis

Abstract

Background and AimRuptured hepatocellular carcinoma (rHCC) is classified as T4 according to the TNM staging system with a very poor (does not achieve expected) prognosis, which has always been controversial. This study aimed at assessing the specific impact of different tumor diameters on the posttreatment prognosis of BCLC stage 0/A rHCC patients.MethodsData from 258 patients with BCLC stage 0/A HCC treated in our center from January 2008 to December 2017 were collected, including 143 rHCC patients and 115 patients with non-ruptured HCC (nrHCC). With the help of X-tile software, we determined the cutoff value of the tumor diameter in patients with rHCC. Using 8 cm as the cutoff, we divided rHCC patients into Small-rHCC (n = 96) and Large-rHCC (n = 47) groups, compared the prognoses of the S-rHCC and L-rHCC groups, as well as the prognoses of the two groups with the nrHCC group using the Kaplan–Meier method, and screened the prognostic factors of rHCC patients using the multivariate Cox risk model.ResultsThe OS of the S-rHCC group was significantly higher than that of the L-rHCC group [HR = 2.41 (1.60–3.63)], and the OS of the nrHCC group was comparable to that of the S-rHCC group (P = 0.204). In patients treated with surgery only, OS and RFS were also comparable in the S-rHCC nrHCC group. Meanwhile, multivariate Cox regression analysis revealed that alpha-fetoprotein (AFP), alkaline phosphatase (ALP), and the main method of treatment were also prognostic factors for OS in patients with rHCC.ConclusionsRuptured HCC with a relatively small diameter (≤8 cm) can also achieve the same prognosis as nrHCC patients after aggressive treatment. It is also not recommended to include all patients with rHCC in stage T4.

Treatment and prognosis study of spontaneous rupture hemorrhage in hepatocellular carcinoma: Recommendations for adding the A1 stage to the BCLC staging system

“…However, larger tumor diameters may be associated with a higher risk of positive margins 26 . Research has shown that patients with small‐volume rHCC who undergo curative resection can achieve a prognosis similar to that of nrHCC patients 15,27 . Therefore, based on the characteristics of BCLC stage A tumors, we recommend that early surgical resection should be considered as the primary treatment option for patients with a single tumor with a diameter >2 cm, who have spontaneously ruptured without evidence of peritoneal implantation and who have good liver function (Child–Pugh score) and ECOG performance status.…”

Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes

“…Based on recently reported data on equivalent survival outcomes in patients with ruptured HCC, the Sixth edition of the Liver Cancer Study Group of Japan (LCSGJ) guidelines does not consider tumor rupture in T staging. In contrast, the Eighth edition of the American Joint Committee on Cancer guidelines has classified HCC rupture as T4 stage ( 29 ). The results of the present study indicate that ruptured HCC may have prognostic significance in predicting a poorer OS.…”

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

“…However, there are some studies that have been reported BCLC stage C patients appear to have substantially lower 5-year rates of overall survival after hepatic resection (<25%) [ 19 , 20 ] than patients who experience tumor rupture (29–49%) [ 10 , 21 ]. As a result, several investigators have questioned the assignment of HCC patients to stage T4 after tumor rupture [ [22] , [23] , [24] ]. The appropriateness of such staging may be particularly important to resolve for patients who experience tumor rupture while their disease is in BCLC stage A or B, whom some clinicians routinely assign to BCLC stage C in order to simplify treatment decision-making.…”