Clinical Features and Prognostic Factors of Spontaneous Ruptured Hepatocellular Carcinoma

自發性肝癌破裂出血的臨床特徵與預後分析

陳季宏(Chi-Hung Chen) ； 黃仁杰(Jen-Chieh Huang) ； 辛政憲(Jeng-Shiann Shin)

《臺灣消化醫學雜誌》 30卷3期 (2013/09) Pp. 248-255

https://doi.org/10.6557/GJT.201309_30(3).0001

摘要

研究動機：由過去的文獻可知自發性肝癌破裂出血在臨床上並不常見，但卻常伴隨著很高的死亡率，本篇的研究希望了解自發性肝癌破裂出血的病人臨床特徵與早期預後相關的因子。研究材料與方法：本研究利用回顧性的方式分析本院近十年的自發性肝癌破裂出血的病例，針對基本資料、病史、肝癌診斷與破裂出血的時間、臨床生化數值、腫瘤大小、臨床分期、治療選擇與存活時間逐一記錄、利用SPSS統計軟體、以t-test、Pearson chi-squared test、Fisher's exact test and Kaplan-Meier test對資料庫做分析，藉以找出臨床特徵與早期預後相關因子。結果：共計42位自發性肝癌破裂出血的病人進入分析，在初次診斷肝癌併破裂出血的病人共有24人，肝癌追蹤治療中發生破裂出血的病人有18人，兩組在Child－Pugh分類（P＝0.043），BCLC stage腫瘤分期（P＝0.029），腫瘤型態（P＝0.012），血中白蛋白值（2.99 ± 0.53 g/dL vs. 2.52 ± 0.63 g/dL；P＝0.013）與總膽紅素（1.34 ± 1.30 mg/dL vs. 3.13 ± 3.43 mg/dL；P＝0.048）均有統計學上的差別。在30天預後因子分析中，血中白蛋白值與肝癌破裂出血後30天早期存活與否有關（OR：0.125；P＝0.019)。肝癌破裂出血後累積存活月數也以初次診斷肝癌併破裂出血的人較長（P＝0.0304）。結論：本研究發現相較於肝癌追蹤治療中發生破裂出血的病人，初次診斷肝癌併破裂出血的病人有較好的肝功能，肝癌破裂出血後的累計存活月數也比較長。但對於此一結果仍需更多前瞻性研究來證實。

關鍵字

自發性肝癌破裂 ； 肝癌出血

並列摘要

Background and Aims: Ruptured hepatocellular carcinoma (HCC) is a rare, life-threatening event. We designed a retrospective study to better define the clinical features and prognostic factors of patients with ruptured HCC.Materials and Methods: We reviewed the cases of all patients with ruptured HCC treated in our hospital from January 2000 to December 2011. Total 42 patients with ruptured HCC were enrolled and we divided the cases into two groups according to the timing of HCC diagnosis. In one group (first diagnosis group), HCC and rupture were diagnosed simultaneously (n = 24), and in a second group (follow-up group), HCC rupture had been discovered during HCC follow-up (n = 18). We used the t-test, the Pearson chi-squared test, Fisher's exact test, and the Kaplan-Meier test to assess the results.Results: Statistically significant differences were found between the first diagnosis group and the follow-up group, respectively, in BCLC stage (P = 0.029), Child-Pugh classification (P = 0.043), morphology of tumors (P = 0.012), total bilirubin levels (1.34 ± 1.30 mg/dL vs. 3.13 ± 3.43 mg/dL; P = 0.048), and albumin levels (2.99 ± 0.53 g/dL vs. 2.52 ± 0.63 g/dL; P = 0.013). The 30-day survival rate was not significantly different between the groups (P = 0.679). When prognostic factors for 30-day survival were analyzed, serum albumin levels were related to 30-day mortality (OR: 0.125; P = 0.019). Kaplan-Meier survival analysis showed that the cumulative survival rate after rupture of HCC was higher in patients with ruptured HCC in first diagnosis group than in follow-up group (P = 0.0304).Conclusions: Despite the limitations of the retrospective study design, the results revealed differences between patients with ruptured HCC in first diagnosis group and follow-up group. Patients with ruptured HCC in first diagnosis group had better liver function reserve and long term survival after rupture of HCC. A future prospective study is needed to confirm the results.

並列關鍵字

spontaneous ruptured hepatocellular carinoma ； hepatoma bleeding