Risk Factors For Early Death, Prognostic Factors, And Efficacy Of Different Treatments In The Diagnosis Of Spontaneous Rupture And Hemorrhage In Newly Diagnosed Primary Liver Cancer

Objective 1.To identify the risk factors for early mortality(≤ 30 days)in patients with ruptured naive hepatocellular carcinoma(HCC),including treatment modality.2.To analyze the prognostic factors of spontaneous ruptured HCC,including treatment modality.Materials and methods 1.Between Jun 2012 and Dec 2016,The medical records of 80 ruptured naive HCC patients who received conservative treatment or transarterial embolization(TAE)as initial therapy were retrospectively analyzed.According to the survival state within 30 days,the selected patients were divided into survival group and dead group.The possible risk factors related to early mortality were analyzed by using univariate and multivariate logistic regression model(P<0.05).2.We retrospectively investigated 130 patients with spontaneous ruptured HCC in our hospital from June 2012 to December 2017.In the 130 patients,51 were received transarterial embolization(TAE)as initial treatment,30 were received partial hepatic resection as initial treatment and 49 were treated by combined method(8 patients were treated by surgical resection followed by TAE,41 patients were treated by TACE followed by surgical resection).Patients’ characteristics were collected and the possible factors related to prognosis were analyzed by using univariate and multivariate logistic regression model(P<0.05).Results 1.Of 80 patients,the early mortality was 28.8%.Univariate analysis showed that the proportion of patients with shock on admission(P=0.008),conservative treatment(P<0.001),poor Child-Pugh class(P<0.001)and advanced modified LCSGJ tumor stage(P<0.001)in the dead group was significantly higher than those in the survival group,and the patients’ initial hemoglobin level of dead group(P<0.001)was also significantly lower than that of survival group.Multivariate logistic regression analysis indicated that patients with shock on admission(OR:5.543,P=0.026),poor Child-Pugh class[class B(OR:10.395,P=0.009)、class C(OR:23.633,P=0.006)]and conservative treatment(OR:8.576,P=0.002)were independent risk factors for early mortality.2.Univariate analyses showed that the size and number of tumors,ALT and ALB level,Child-Pugh class and treatment choice were significant prognostic factors.Multivariate analysis results indicated that number of tumors(P<0.001),tumor size(P=0.017),ALT level(P=0.011),Child-Pugh class(P<0.001)and treatment choice(P<0.001)were the independent prognostic factors.Conclusion 1.Among ruptured naive HCC patients,the early mortality is high.For such patients,actively correcting shock while improving liver function as early as possible should undoubtedly have great significance for improving the prognosis.Additionally,reasonably expanding the indications of interventional therapy is essential.2.The results of this study indicated that size and number of tumors,ALT and ALB level,Child-Pugh class and treatment choice were significant prognostic factors of spontaneous ruptured HCC patients.And patients who received combined treatment could achieve a better survival time than those who treated by TAE only or surgical resection only.