A Clinical Treatment Strategy For Ruptured Primary Hepatocellular Carcinoma

Objective:The aim of the present study is to invesigate the prognoses of patients with ruptured bleeding hepatocellular carcinoma(HCC)after resection combined with interventional therapy,and clarify the relevant prognostic factors.Method: This study was conducted on 50 consecutive patients diagnosed with ruptured bleeding hepatocellular carcinoma from March 2013 to December 2016 in our hospital,(According to the inclusion criteria,11 cases that did not meet the conditions of the study were excluded.)Patients were divided into two groups according to their different sequences of therapies: A group took resection after interventional therapy(n=20)and B group took interventional therapy after resection(n=30).During the study,COX regression multivariate analysis were performed and the 1-year,2-year,3-year overall survival rate(OS)of each patient was respectively calculated on the basis of the physical data and follow-up information of patients.Result: There were no differences in clinical data and perioperative complications between the two groups.In group A took resection after interventional therapy,the overall survival rate of patients in the first year,the second year,and the third year was100%,80%,and 34%,respectively.In group B took interventional therapy after resection,the overall survival rates of patients in the first year,second year,and third year were 92%,43%,and 0%,respectively.The 3-year OS see significant difference(OS:34% vs.0%,P=0.044).Multivariate survival analysis showed that age(HR 1.376,P<0.001,95%CI 1.191~1.589),blood transfusions(HR 1.001,P=0.024,95%CI1.000~1.003),total bilirubin(HR 4.354,P<0.001,95% CI 2.131~5.927)and INR(HR0.275,P=0.031,95%CI 0.132~0.618)were two prognostic factors affecting the overall survival rates of patients.Conclusion: The combined therapy(surgical resection and interventional therapy)was effective for patients prognoses with ruptured bleeding hepatocellular carcinoma,however the therapy that took resection after interventional therapy can extend the overall survival rate.