Risk Factors and Prognosis of Spontaneously Ruptured Hepatocellular Carcinoma in Thailand

Abstract

Objective: Hepatocellular carcinoma (HCC) is the fatal cancer worldwide. Spontaneously Rupture remains<br />important complication of HCC. The incidence of spontaneous HCC rupture was high in ASEAN but limited studies<br />were reported. The aim of this study was to evaluate predictors and overall survival of ruptured HCC in tertiary care<br />center in Thailand. Methods: We conducted a retrospective cohort study of HCC patients aged ≥15 years old during<br />January 2012-January 2016 and followed up through June 2016 at Thammasat University Hospital, Thailand. All<br />clinical information, laboratory and radiologic findings were collected from reviewing computer data base of medical<br />records. Results: 333 patients had completely retrievable information. Of which, 51patients (15.3%) had spontaneous<br />ruptured HCC. Clinical symptoms with abdominal discomfort and anemic symptoms were significantly higher in<br />ruptured than non-ruptured HCC groups. (76.47% vs.39.36%: p<0.001, 13.73vs.0.71%, p<0.001). Furthermore, size<br />of tumors, presences of metastasis and serum AFP>200 ng/mL were significantly higher in ruptured than non-ruptured<br />HCC groups (10.29cm. vs. 6.47cm. p<0.001, 17.65% vs. 8.16%, p=0.034, 60.78% vs. 36.88%, p=0.001, respectively).<br />In multivariate analysis, age, abdominal discomfort, anemic symptoms, Child-Pugh score>6 were independent risk<br />factors of HCC rupture (OR=0.96, 95%CI=0.93-0.99, p=0.02; OR=3.47, 95%CI=1.26-9.6, p=0.016; OR=54.51,<br />95%CI=7.09-418.89, p<0.001; OR=2.62, 95%CI=1.09-6.31, p=0.031, respectively). 1-year and 2-year survival rates<br />of ruptured HCC were 66.9% and 44.6% respectively. Conclusions: Age, abdominal discomfort, anemic symptoms<br />and Child-Pugh score>6 might be predictive factors of spontaneous ruptured HCC. Ruptures of HCC remained a fatal<br />disease with poor survival rate in Thailand. Appropriate treatment in early stage could be effective tool to improve the<br />treatment outcomes