Subclinical Ruptured HCC Patients Undergoing Liver Resection Prognosis

Background Hepatocellular carcinoma (HCC) is the fifth most common malignancy, which is located in the first two categories of the cancer deaths and thousands of people died for HCC and its complications every year. Rupture tumor is one of the most serious complications. Most of patients with spontaneous rupture of hepatocellular carcinoma had obvious clinical manifestations. It mainly was manifestations of sudden abdominal pain and shock due to acute hemorrhagic. We found that a few of patients had a tumor rupture without acute hemorrhagic while the HCC was diagnosed by radiolgic image including the limitations of blood next to the tumor and (or) a tumor gap was seen in operation when removal of the tumor surface coverings. The phenomenon was different with the patients which had rupture tumor with acute hemorrhagic, we called subclinical rupture type HCC. Up to now, Few papers was found about the subclinical ruptured type HCC.Objective To discuss prognosis and factors of patients with the subclinical ruptured type hepatocellular carcinoma (HCC) underwent elective hepatectomy.Methods A retrospective analysis of614patients’clinical data between January1997to December2010in the Affiliated Hospital of Medical College, Qingdao University underwent elective hepatectomy was done. The chi-square test and t tset was used simple factors analysis, Logistic regression analysis was used to multiple factors analysis. Survival analysis and comparison were conducted using Kaplan-Meier method and Log-rank test. Prognostic risk factor analysis was conducted using Cox proportional hazards regression model analysis.Results In614HCC patients underwent liver resection,30patients were found with subclinical ruptured type (rupture group),584patients without rupture (non-ruptured group). In ruptured group, there were25males and5females, aged29to73years (median age55years); in non-ruptured group, there were488males and96females, aged14to82years (median age55years). In ruptured group, the patients with RO resection, hepatic resection>1segment, surgical margin<0.5cm, blood transfusion, intraoperative blood loss≥1000ml, tumor diameter>5cm and poorly differentiation were significantly more than patients in non-ruptured group (χ2=37.609,6.021,6.497,20.982,19.498,22.944,8.222; P<0.05). By Logistic regression analysis, the results showed that non-RO resection and tumor diameter>5cm was the important feature for subclinical ruptured type HCC (OR=3.772,5.045; P<0.05). Kaplan-Meier analysis showed a median overall survival time was9months in ruptured group and56months in the non-ruptured group. The overall survival rate for1-,3-,5-year was50.0%,22.2%,5.9%in ruptured group and86.0%,62.6%,48.9%in non-ruptured group respectively (χ2=38.879, P<0.05). Cox proportional hazards regression model analysis showed that poorly differentiated tumor was an independent risk factor for patients in ruptured group (RR=3.736, P<0.05).Conclusion Non-RO resection and tumor diameter>5cm was the important feature for patients with subclinical ruptured type HCC. The prognosis of the patients with subclinical ruptured type HCC underwent elective liver resection was poor. Poorly differentiation was an independent risk factor for these patients’prognosis. For these HCC patients, the MDT (multidisciplinary team) and regular follow-up after surgery is important to reduce HCC recurrence and improve the prognosis.