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KMID : 0371420190960060275
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Annals of Surgical Treatment and Research
2019 Volume.96 No. 6 p.275 ~ p.282
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Staged partial hepatectomy versus transarterial chemoembolization for the treatment of spontaneous hepatocellular carcinoma rupture: a multicenter analysis in Korea
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Lee Hyung-Soon
Choi Gi-Hong
Choi Jin-Sub
Han Kwang-Hyub
Ahn Sang-Hoon
Kim Do-Young
Park Jun-Yong
Kim Seung-Up
Kim Sung-Hoon
Yoon Dong-Sup
Kim Jae-Keun
Choi Jong-Won
Kim Soon-Sun
Park Ha-Na
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Abstract
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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.
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KEYWORD
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Hepatocellular carcinoma, Spontaneous rupture, Hepatectomy, Therapeutic chemoembolization
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