Ann Surg Treat Res.  2019 Jun;96(6):275-282. 10.4174/astr.2019.96.6.275.

Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea

Affiliations
  • 1Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 2Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. choi5491@yuhs.ac
  • 3Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 5Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 7Department of Internal Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
  • 8Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Abstract

PURPOSE
The aim of this study was to identify the prognostic factors and compare the long-term outcomes of staged hepatectomy and transarterial chemoembolization (TACE) for patients with spontaneous rupture of hepatocellular carcinoma (HCC).
METHODS
This study is a multicenter, retrospective analysis of patients with newly diagnosed ruptured HCC. To compare overall survival between staged hepatectomy group and TACE alone group, we performed propensity score-matching to adjust for significant differences in patient characteristics. To identify prognostic factors, the clinical characteristics at the time of diagnosis of tumor rupture were investigated using Cox-regression analysis.
RESULTS
From 2000 to 2014, 172 consecutive patients with newly diagnosed ruptured HCC were treated in 6 Korean centers. One hundred seventeen patients with Child-Pugh class A disease were identified; of which 112 were initially treated with transcatheter arterial embolization (TAE) for hemostasis and five underwent emergency surgery for bleeder ligation. Of the 112 patients treated with TAE, 44 underwent staged hepatectomy, 61 received TACE alone, and 7 received conservative treatment after TAE. Those that underwent staged hepatectomy had significantly higher overall survival than those that underwent TACE alone before matching (P < 0.001) and after propensity score-matching (P = 0.006). Multivariate analysis showed that type of treatment, presence of portal vein thrombosis, pretreatment transfusion >1,200 mL, and tumor size >5 cm were associated with poor overall survival.
CONCLUSION
Staged hepatectomy may offer better long-term survival than TACE alone for spontaneous rupture of HCC. Staged hepatectomy should be considered in spontaneous rupture of HCC with resectable tumor and preserved liver function.

Keyword

Hepatocellular carcinoma; Spontaneous rupture; Hepatectomy; Therapeutic chemoembolization

MeSH Terms

Carcinoma, Hepatocellular*
Chemoembolization, Therapeutic
Diagnosis
Emergencies
Hemostasis
Hepatectomy*
Humans
Korea*
Ligation
Liver
Multivariate Analysis
Retrospective Studies
Rupture*
Rupture, Spontaneous
Venous Thrombosis

Figure

  • Fig. 1 Patient selection schematic. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization. a)Supportive care, radiotherapy and chemotherapy.

  • Fig. 2 Comparison of overall survival between staged hepatectomy and TACE alone before matching (A) and after propensity score-matching (B). TACE, transarterial chemoembolization.


Cited by  1 articles

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

J Liver Cancer. 2023;23(1):1-120.    doi: 10.17998/jlc.2022.11.07.


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