Risk Factors and Survival Analysis of Spontaneously Ruptured Hepatocellular Carcinoma: A Retrospective Cohort Study in Bilateral Centers

Abstract

Background: This study aimed to analyze risk factors for spontaneously ruptured hepatocellular carcinoma (HCC) and investigate the impact of spontaneous tumor rupture (STR) on the long-term survival of HCC patients treated by transcatheter arterial chemoembolization (TACE).

Methods: A retrospective cohort of patients with a diagnosis of HCC was divided into the ruptured group and the non-ruptured group. Uni- and multivariate logistic regression analyses were performed for risk factors. The survival outcomes for the patients treated with hepatectomy, TACE, or best supportive care (BSC) in ruptured group were compared. The prognosis of HCC patients treated with TACE were compared using propensity score-matching (PSM).

Results: The study enrolled 1103 HCC patients for risk factors analysis. Logistic regression analysis showed that male sex, liver cirrhosis, tumor protrusion, tumor diameter greater than 5 cm, macrovascular invasion, alpha fetoprotein (AFP) of 400 ng/mL or higher, and ascites were independent risk factors for STR. A COX regression analysis indicated that tumor diameter greater than 5 cm, AFP of 400 ng/mL or higher, and STR were independent prognostic factors for overall survival (OS). Furthermore, tumor diameter greater than 5 cm and macrovascular invasion were independent prognostic factors for progress-free survival (PFS). In ruptured group, treatment with hepatectomy indicated the best prognosis, followed by treatment with TACE and BSC. Also, in TACE group, the non-ruptured HCC patients had significant longer OS than the ruptured HCC patients, whereas PFS showed no statistical difference before or after PSM.

Conclusions: Male sex, liver cirrhosis, tumor protrusion, tumor diameter greater than 5 cm, macrovascular invasion, AFP of 400 ng/mL or higher, and ascites are independent risk factors for STR. In ruptured group, treatment with hepatectomy indicated the best prognosis, followed by treatment with TACE and BSC. For the HCC patients treated with TACE, STR was independent prognostic factor for OS but not PFS.

Keywords: Hepatectomy; Hepatocellular carcinoma; Propensity score matching; Risk factors analysis; Spontaneous tumor rupture; Survival analysis; TACE.