Hepatectomy for ruptured hepatocellular carcinoma classified as Barcelona Clinic Liver Cancer stage 0/A: The optimal treatment.

Abstract

BACKGROUND AND AIMS:

Ruptured hepatocellular carcinoma (rHCC) generally has a very poor prognosis and is currently classified as T4 in the tumor-node-metastasis (TNM) staging system. In this study, we aimed to demonstrate the actual impact of rHCC, as well as the positive effect of hepatectomy in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0/A rHCC.

METHODS:

We enrolled 86 patients with rHCC after surgery and 526 patients with non-rHCC after surgery or transcatheter arterial chemoembolization (TACE). Survival curves were plotted using the Kaplan-Meier method to compare the postoperative prognosis of patients with rHCC with that of patients with non-rHCC. Univariate and multivariate Cox regression analyses were used to identify the risk factors affecting patient survival.

RESULTS:

BCLC stage 0/A rHCC treated with surgery had a worse prognosis than BCLC stage 0/A non-rHCC treated with surgery (overall survival [OS]: hazard ratio [HR] = 3.12 [2.24-4.34], P < 0.001; recurrence-free survival [RFS]: HR = 2.26 [1.65-3.09], P < 0.001). Rupture was an independent prognostic factor in patients with BCLC stage 0/A rHCC (OS: HR = 1.685 [1.416-2.006], P < 0.001; RFS: HR = 1.484 [1.267-1.737], P < 0.001), and patients with BCLC stage 0/A rHCC who underwent surgery had a comparable prognosis to patients with BCLC stage B HCC who underwent surgery or TACE (OS: P = 0.78).

CONCLUSIONS:

Patients classified as having BCLC stage 0/A rHCC can achieve comparable outcomes to patients with BCLC stage B HCC after hepatectomy. However, not all patients with rHCC should be classified as T4 in the TNM staging system.

• Authors: Feng Xia, Zhiyuan Huang, Qiao Zhang, Elijah Ndhlovu, Mingyu Zhang, Xiaoping Chen, Yifa Chen, Bixiang Zhang, Peng Zhu
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 48 Issue 9 Pg. 2014-2022 (09 2022) ISSN: 1532-2157 [Electronic] England
• PMID: 35595579 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Topics

• Carcinoma, Hepatocellular (pathology, surgery)
• Chemoembolization, Therapeutic (methods)
• Hepatectomy
• Humans
• Liver Neoplasms (pathology, surgery)
• Neoplasm Staging
• Prognosis
• Retrospective Studies