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The treatment strategy and outcome for spontaneously ruptured hepatocellular carcinoma: a single-center experience in 239 patients

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

There exist no treatment guidelines for spontaneously ruptured hepatocellular carcinoma (srHCC) and its prognosis remains controversial.

Methods

Patients were retrospectively enrolled and grouped based on hemodynamics and tumor resectability. The 30-day mortality, 5-year overall survival (OS), progression-free survival (PFS), peritoneal metastasis (PM) and intrahepatic metastasis (IM) rates were compared.

Results

In general, 239 patients were classified into four groups: patients with stable hemodynamics underwent semi-elective hepatectomy (n = 119), and those with unstable hemodynamics received emergent hepatectomy (n = 17), sequential hemostatic-transcatheter arterial chemoembolization (TACE)/-laparotomy with late hepatectomy (n = 49), or TACE only (n = 54). Hepatectomy was safer and provided better OS and PFS than TACE both before and after propensity score matching. Emergent hepatectomy was associated with higher 30-day mortality (6.2%, P < 0.05) and poorer prognosis whereas semi-elective hepatectomy and sequential treatment had comparable mortality (both 0%) and survival (36.3% vs 45.2%, P > 0.05). Compared with hemostatic TACE in the sequential treatment group, early surgical intervention (semi-elective hepatectomy, emergent hepatectomy, and sequential laparotomy with late hepatectomy) decreased PM (13.6% vs 34.2%, P = 0.003) whereas had higher IM (68.0% vs 50.0%, P = 0.039), but neither procedure had affected OS. In srHCC patients with high risk of recurrence (multiple tumors, micro- and macro-vascular invasion), postoperative adjuvant TACE improved OS.

Conclusion

Hepatectomy could provide better prognosis than TACE for srHCC patients while semi-elective hepatectomy and sequential hemostatic-TACE with staged hepatectomy are viable options for srHCCs with stable and unstable hemodynamics, respectively.

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Availability of data and materials (data transparency)

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

This study was jointly supported by the National Key R&D Program of China (2019YFC1315800, 2019YFC1315802), National Natural Science Foundation of China (No.82150004, 81830102, 81772578, 81802991), Fudan University (IDF152064/014), Zhongshan Hospital Fudan University (2021ZSYQ09), and Shanghai Municipal Key Clinical Specialty.

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Author notes

  1. Ao Huang and De-Zhen Guo have contributed equally to this study.

Authors and Affiliations

  1. Department of Liver Surgery and Transplantation; Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education; Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai, 200032, China

    Ao Huang, De-Zhen Guo, Yu-Peng Wang, Jia Fan, **n-Rong Yang & Jian Zhou

  2. Institute of Biomedical Sciences, Fudan University, Shanghai, 200032, China

    Jia Fan & Jian Zhou

  3. State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, 200032, China

    Jian Zhou

Authors
  1. Ao Huang
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  2. De-Zhen Guo
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  4. Jia Fan
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Correspondence to Jian Zhou.

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This retrospective study has been approved and recorded by the scientific research department of Zhongshan Hospital, Fudan University and is in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Huang, A., Guo, DZ., Wang, YP. et al. The treatment strategy and outcome for spontaneously ruptured hepatocellular carcinoma: a single-center experience in 239 patients. J Cancer Res Clin Oncol 148, 3203–3214 (2022). https://doi.org/10.1007/s00432-022-03916-3

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  • DOI: https://doi.org/10.1007/s00432-022-03916-3

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