Does spontaneous tumor rupture always has an adverse prognostic impact on patients with resectable hepatocellular carcinoma?

Abstract

Introduction: Spontaneous tumor rupture (STR) is a life-threatening complication of hepatocellular carcinoma (HCC) with high mortality. Previous study showed that 20% patients with STR could eventually receive hepatectomy after initial haemostasis and attain long-term survival. Nonetheless, the prognostic impact of STR on the prognosis of these patients in relation to non-ruptured resectable HCC is still not known. Method: From 1989 to 2010, a total of 1338 patients received hepatectomy and 84 patients had STR before resection (Group I). Their clinicopatholgical data and survival outcomes were compared with patients who had resections of non-ruptured HCC (Group II). p ≤ 0.05 was regarded as significant. Results: There was no significant difference in preoperative liver function and ICG value. Group I had significantly larger tumor size (10 cm vs. 5.5 cm), higher incidence of multiple tumors (38.1% vs. 27.3%) and microvascular invasion (61.9% vs. 46.5%). The incidence of major vascular invasion was not significantly different between both groups (10.7% vs. 8.1%). When Group I was stratified according to 7th AJCC/TNM classification, after excluding STR as an element from staging, the 3- and 5-year disease-free survival (DFS) rates for T1 were 41.8% and 31.4% in Group I; 61.9% and 51.2% in Group II (p = 0.023); for T2 were 15.4% and 7.7% in Group I, and 32.0% and 24.8% in Group II(p = 0.007); for T3 were 14.7% and 9.8% in Group I, and 16.6% and 13.8% in Group II (P = 0.626). Furthermore, the DFS in Group I were significantly worsened than Group II when tumor size 5-10 cm (5-year DFS: 6.3% vs. 29.3%, P = 0.053) but not when tumor size ≤5 cm (5-year DFS: 31.3% vs. 41.2%, p = 0.224) or >10 cm (5-year DFS 10.4% vs. 15.4%, p = 0.259). Conclusions: STR only has an adverse prognostic impact on early staged or medium-sized tumors. Redefining the significance of STR in future AJCC/TNM staging is indicated.