Risk Factors And Clinical Outcomes For Spontaneous Rupture Of Primary Hepatic Carcinoma

Objective The aims of this study were to explore the risk factorsrelating to spontaneous rupture of primary liver cancer, to analyze differenttherapy strategies for primary liver cancer.Methods A retrospective analysis of56cases with spontaneous ruptureof primary liver cancer in Department of Hepatobiliary Surgery, The FirstAffiliated Hospital of Chongqing Medical University from Jul.2006to Dec.2012was conducted, and compared with56randomly selected concurrentcases without rupture of primary liver cancer. Risk factors were exploredfor their possible association with rupture of primary liver cancer byLogistic regression model.56cases were treated by different strategies.25patients received conservative treatment,18patients underwent liverresection,8patients received palliative surgery and5patients underwenttransarterial embolization (TAE).Results The univariate analysis showed that portal tumor thrombus,alpha fetoprotein(AFP), tumor protrusion>1cm above the liver surface,prothrombin time(PT), Fibrinogen (FIB), HBeAg were associated with increased risk of spontaneous rupture of primary liver cancer (P<0.05).Multivariate analysis identified that tumor protrusion>1cm above the liversurface(P=0.022), FIB (P=0.020), and HBeAg (P=0.022) were significantindependent risk factors for spontaneous rupture of primary liver cancer.The6-,12-,36-mo survival rate and MST were significantly higher in theliver resection group (77.8%、55.6%、16.7%、13mo） than in theconservative treatment group（12%、4%、0%、2mo），palliative surgerygroup（12.5%、0%、0%、4mo）and TAE group（0%、0%、0%、4mo）,respectively(P<0.001).Conclusions Tumor protrusion>1cm above the liver surface, FIB,HBeAg are significant independent risk factors for spontaneous rupture ofprimary liver cancer. Emergency liver resection appears to be a moreeffective treatment strategy for selected patients with spontaneous rupture ofprimary liver cancer than conservative treatment, palliative surgery andTAE.