Adham E Obeidat1, Linda L Wong2. 1. Department of Medicine, University of Hawaii John A. Burns School of Medicine. 1356 Lusitana St., UH Tower. Honolulu, HI, 96813, United States. 2. Department of Surgery, University of Hawaii John A. Burns School of Medicine. 550 South Beretania St., Suite 403. Honolulu, HI, 96813, United States.
Abstract
Background: Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially fatal complication and the third leading cause of death in patients with HCC after tumor progression and liver failure. Previous studies suggested that improved HCC surveillance has decreased the incidence of rupture. This study aims to characterize patients with ruptured HCC over time and identify predictors of rupture. Methods: We retrospectively reviewed a prospectively collected database of 1451 HCC patients to identify cases with rupture and predictors of rupture. Data were divided into three 9-year eras to compare and trend patient/tumor characteristics and rupture. Results: Fifty-seven patients (3.9%) presented with spontaneous HCC rupture and the following characteristics: mean age 62.6 years, 73.7% males, 41% cirrhosis, and mean tumor size of 8.0 cm. On multivariate analyses, predictors of rupture included obesity, tumor >5 cm, and single tumors, whereas the presence of cirrhosis was a negative predictor for rupture.Across three eras, there were changes in disease etiology and decreases in tumor size, and more HCCs were found with surveillance. However, more patients were noncirrhotic, and the incidence of spontaneous rupture was unchanged over time. Conclusion: Despite improved early detection of HCC over time, the incidence of rupture has been unchanged. The persistent incidence of rupture may possibly be attributed to increasing proportion of fatty liver-related HCC patients who lack traditional risk factors for surveillance and may not have cirrhosis. Better identification of fatty liver disease and determining which patients need HCC surveillance may be needed in the future to prevent spontaneous rupture.
Background: Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially fatal complication and the third leading cause of death in patients with HCC after tumor progression and liver failure. Previous studies suggested that improved HCC surveillance has decreased the incidence of rupture. This study aims to characterize patients with ruptured HCC over time and identify predictors of rupture. Methods: We retrospectively reviewed a prospectively collected database of 1451 HCC patients to identify cases with rupture and predictors of rupture. Data were divided into three 9-year eras to compare and trend patient/tumor characteristics and rupture. Results: Fifty-seven patients (3.9%) presented with spontaneous HCC rupture and the following characteristics: mean age 62.6 years, 73.7% males, 41% cirrhosis, and mean tumor size of 8.0 cm. On multivariate analyses, predictors of rupture included obesity, tumor >5 cm, and single tumors, whereas the presence of cirrhosis was a negative predictor for rupture.Across three eras, there were changes in disease etiology and decreases in tumor size, and more HCCs were found with surveillance. However, more patients were noncirrhotic, and the incidence of spontaneous rupture was unchanged over time. Conclusion: Despite improved early detection of HCC over time, the incidence of rupture has been unchanged. The persistent incidence of rupture may possibly be attributed to increasing proportion of fatty liver-related HCC patients who lack traditional risk factors for surveillance and may not have cirrhosis. Better identification of fatty liver disease and determining which patients need HCC surveillance may be needed in the future to prevent spontaneous rupture.
Authors: Lewis R Roberts; Claude B Sirlin; Feras Zaiem; Jehad Almasri; Larry J Prokop; Julie K Heimbach; M Hassan Murad; Khaled Mohammed Journal: Hepatology Date: 2017-11-29 Impact factor: 17.425
Authors: Natassia P Tan; Ammar Majeed; Stuart K Roberts; Paul J Gow; Penny Hey; Xianjun Mah; Mark Goodwin; Siddharth Sood; John Lubel; Amanda Nicoll; Anouk Dev; Sally J Bell; William W Kemp Journal: Med J Aust Date: 2020-01-25 Impact factor: 7.738
Authors: V Vergara; A Muratore; H Bouzari; R Polastri; A Ferrero; G Galatola; L Capussotti Journal: Eur J Surg Oncol Date: 2000-12 Impact factor: 4.424
Authors: Narendra Battula; Mansoor Madanur; Oliver Priest; Parthi Srinivasan; John O'Grady; Michael A Heneghan; Matthew Bowles; Paolo Muiesan; Nigel Heaton; Mohamed Rela Journal: Am J Surg Date: 2008-10-16 Impact factor: 2.565