Risk Factors and Prognosis of Spontaneously Ruptured Hepatocellular Carcinoma in Thailand

Abstract

Objective: Hepatocellular carcinoma (HCC) is the fatal cancer worldwide. Spontaneously Rupture remains important complication of HCC. The incidence of spontaneous HCC rupture was high in ASEAN but limited studies were reported. The aim of this study was to evaluate predictors and overall survival of ruptured HCC in tertiary care center in Thailand. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years old during January 2012-January 2016 and followed up through June 2016 at Thammasat University Hospital, Thailand. All clinical information, laboratory and radiologic findings were collected from reviewing computer data base of medical records. Results: 333 patients had completely retrievable information. Of which, 51patients (15.3%) had spontaneous ruptured HCC. Clinical symptoms with abdominal discomfort and anemic symptoms were significantly higher in ruptured than non-ruptured HCC groups. (76.47% vs.39.36%: p<0.001, 13.73vs.0.71%, p<0.001). Furthermore, size of tumors, presences of metastasis and serum AFP>200 ng/mL were significantly higher in ruptured than non-ruptured HCC groups (10.29cm. vs. 6.47cm. p<0.001, 17.65% vs. 8.16%, p=0.034, 60.78% vs. 36.88%, p=0.001, respectively). In multivariate analysis, age, abdominal discomfort, anemic symptoms, Child-Pugh score>6 were independent risk factors of HCC rupture (OR=0.96, 95%CI=0.93-0.99, p=0.02; OR=3.47, 95%CI=1.26-9.6, p=0.016; OR=54.51, 95%CI=7.09-418.89, p<0.001; OR=2.62, 95%CI=1.09-6.31, p=0.031, respectively). 1-year and 2-year survival rates of ruptured HCC were 66.9% and 44.6% respectively. Conclusions: Age, abdominal discomfort, anemic symptoms and Child-Pugh score>6 might be predictive factors of spontaneous ruptured HCC. Ruptures of HCC remained a fatal disease with poor survival rate in Thailand. Appropriate treatment in early stage could be effective tool to improve the treatment outcomes

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

“…Higher α-FP had contributed to the risk of rHCC in this study. This result does support similar findings regarding α-FP from another retrospective study on rHCC [ 6 ]. However, increasing serum concentrations of α-FP may also be correlated with larger tumor size [ 17 ].…”

“…In a nationwide study from Japan and a retrospective study from Thailand, ascites has been shown to be an independent risk factor of rHCC. However, the explanations of why HCC with ascites is more likely to rupture are still questionable [ 2 6 16 ]. Higher α-FP had contributed to the risk of rHCC in this study.…”

“…Risk factors, such as cirrhosis and tumor size, have been shown to be associated with rHCC [ 6 7 ]. However, there is no reliable clinical routine scoring system to predict rHCC.…”

Spontaneous Rupture of Hepatocellular Carcinoma: New Insights

“…Zhu et al 7 in a retrospective study of 4209 patients with HCC had 200 with rupture and found that hypertension, cirrhosis, tumor size >5 cm, tumor protrusion outside the surface, and extra-hepatic invasion were predictive factors of rupture. Kerdsuknirun et al 34 in 51 ruptured cases out of 333 HCC patients found that age, abdominal pain, anemic symptoms, and Child-Pugh score more than 6 were independent predictive factors of ruptured HCC. Many of the studies on ruptured HCC are from large cohorts in Asia, which are quite homogenous, with viral hepatitis B and C as the main etiology of chronic liver disease.…”

Ruptured Hepatocellular Carcinoma: Current Status of Research

“…Therefore, conservative treatment can improve the general situation of patients to a certain extent, but its effect is not ideal. So, it is recommended that simple conservative treatment is only suitable for dying patients with poor liver function and locally advanced tumors who cannot tolerate transcatheter arterial embolization (TAE) or surgery (39,(55)(56)(57).…”