Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma: An analysis of 1160 cases from a nationwide survey

Taku Aoki, Norihiro Kokudo, Yutaka Matsuyama, Namiki Izumi, Takafumi Ichida, Masatoshi Kudo, Yonson Ku, Michiie Sakamoto, Osamu Nakashima, Osamu Matsui, Masatoshi Makuuchi

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

OBJECTIVE:: The aim of the present study was to investigate the background characteriscs of ruptured hepatocellular carcinoma (HCC) and to clarify the true impact of tumor rupture on patient prognosis in a large patient cohort. BACKGROUND:: Spontaneous tumor rupture of HCC has been associated with a very poor patient prognosis and the current TNM staging systems classify ruptured HCC as T4 based on insufficient evidence. METHODS:: In total, 1106 patients with ruptured HCC were extracted from the database of a nationwide survey conducted in Japan from 2000 to 2005. The clinicopathological parameters associated with HCC rupture were investigated using univariate and multivariate logistic regression models. The survival curves for ruptured and nonruptured HCC were generated and compared to evaluate the impact of the event (rupture) itself on patient prognosis and the TNM staging systems. RESULTS:: The multivariate analyses showed that tumor rupture was associated with both a poor liver functional reserve and an advanced tumor status. Analyses of the survival curves stratified according to the baseline TNM staging showed that tumor rupture had an additional impact on the baseline survival curves without rupture, and the impact corresponded to the addition of 0.5 to 2 stages to the baseline tumor staging. CONCLUSIONS:: The present study suggested that tumor rupture itself had a negative impact on patient survival. However, its impact was not strong enough to cancel the effects of the other tumor-related parameters. Therefore, it may be appropriate to give additional stages to the baseline tumor staging in cases of ruptured HCC.

Original languageEnglish
Pages (from-to)532-542
Number of pages11
JournalAnnals of Surgery
Volume259
Issue number3
DOIs
Publication statusPublished - 2014 Mar

Fingerprint

Spontaneous Rupture
Rupture
Hepatocellular Carcinoma
Neoplasm Staging
Neoplasms
Survival
Logistic Models
Survival Analysis
Surveys and Questionnaires
Japan
Multivariate Analysis
Databases
Liver

Keywords

  • Hepatocellular carcinoma
  • nationwide survey
  • patient outcome
  • spontaneous tumor rupture
  • TNM staging system

ASJC Scopus subject areas

  • Surgery

Cite this

Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma : An analysis of 1160 cases from a nationwide survey. / Aoki, Taku; Kokudo, Norihiro; Matsuyama, Yutaka; Izumi, Namiki; Ichida, Takafumi; Kudo, Masatoshi; Ku, Yonson; Sakamoto, Michiie; Nakashima, Osamu; Matsui, Osamu; Makuuchi, Masatoshi.

In: Annals of Surgery, Vol. 259, No. 3, 03.2014, p. 532-542.

Research output: Contribution to journalArticle

Aoki, T, Kokudo, N, Matsuyama, Y, Izumi, N, Ichida, T, Kudo, M, Ku, Y, Sakamoto, M, Nakashima, O, Matsui, O & Makuuchi, M 2014, 'Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma: An analysis of 1160 cases from a nationwide survey', Annals of Surgery, vol. 259, no. 3, pp. 532-542. https://doi.org/10.1097/SLA.0b013e31828846de
Aoki, Taku ; Kokudo, Norihiro ; Matsuyama, Yutaka ; Izumi, Namiki ; Ichida, Takafumi ; Kudo, Masatoshi ; Ku, Yonson ; Sakamoto, Michiie ; Nakashima, Osamu ; Matsui, Osamu ; Makuuchi, Masatoshi. / Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma : An analysis of 1160 cases from a nationwide survey. In: Annals of Surgery. 2014 ; Vol. 259, No. 3. pp. 532-542.
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AU - Izumi, Namiki

AU - Ichida, Takafumi

AU - Kudo, Masatoshi

AU - Ku, Yonson

AU - Sakamoto, Michiie

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