Risk Factors and Prognosis of Spontaneously Ruptured Hepatocellular Carcinoma in Thailand

Document Type: Research Articles

Authors

1 Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.

2 Patumwan Demonstration School, Srinakharinwirot University, Bangkok,Thailand.

3 Gastric Cancer and Gastrointestinal Diseases Research Center, Thammasat University, Pathumthani, Thailand.

4 Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand.

Abstract

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

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