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目的 了解原发性肝细胞癌(HCC)自发性破裂(SR)的预后影响因素. 方法 2005年1月1日至2011年4月1日间,我院收治HCC-SR 44例,其中19例行根治性肝切除术,同期收治根治性肝切除术治疗非SR的HCC(non-HCC-SR) 137例,对两组患者复发率、无瘤生存率、总体生存率和生存影响因素等作比较.Kaplan-Meier法计算总体生存时间,作Log-rank检验.COX比例风险模型行HCC-SR生存多因素分析.结果 (1)术后1、2、3、5年累积复发率:HCC-SR组分别为78.9％ (15/19)、89.5％ (17/19)、94.7％ (18/19)和94.7％ (18/19);non-HCC-SR组分别为43.1％ (59/137)、54.0％ (74/137)、59.1％ (81/137)和66.4％ (91/137),P值分别为0.006、0.003、0.002和0.014,差异均有统计学意义；(2)术后1、2、3、5年无瘤生存率:HCC-SR组分别为10.5％ (2/19)、5.3％(1/19)、5.3％(1/19)和5.3％(1/19)；non-HCC-SR组分别为40.1％ (55/137)、21.2％ (29/137)、12.4％ (17/137)和4.4％ (6/137),两组比较,仅1年无瘤生存率差异有统计学意义(P=0.011)；(3)术后1、2、3、5年总体生存率:HCC-SR组分别为42.1％ (8/19)、10.5％(2/19)、5.3％(1/19)和5.3％(1/19)；non-HCC-SR组分别为59.1％ (81/137)、32.8％ (45/137)、19.0％ (26/137)和6.6％(9/137),差异均无统计学意义.多因素分析显示肝硬化程度、甲胎蛋白值、治疗方式和HCC-SR分型是HCC-SR的生存影响因素.结论 HCC-SR行根治性肝切除术后复发率明显高于non-HCC-SR,但总体预后类似于non-HCC-SR.肝硬化程度,甲胎蛋白值,治疗方式和HCC-SR分型是HCC-SR的生存影响因素.

Objective To explore the prognostic factors influencing overall survival (OS) in patients with spontaneous rupture of hepatocellular carcinoma (HCC-SR).Methods The medical records of 44 patients with HCC-SR treated in our department from January 1,2005 to April 1 2011 were retrospectively reviewed.The clinical and prognostic data of 19 HCC-SR patients who received curative hepatectomy were compared with data of 137 HCC patients with no SR who were managed by curative hepatectomy during the same period.Type of HCC-SR was defined according to previously established criteria.The clinicopathological data were evaluated for possible associations with OS of HCC-SR by univariate analysis with the Kaplan-Meier method followed by multivariate analysis with the Cox proportional hazard model.Results While some clinical features differed between the HCC-SR patients and non-HCC-SR patients,the postoperative prognosis was comparable between the two groups:(1) The 1-,2-,3-and 5-year postoperative cumulative recurrence rates were 78.9％ (15/19),89.5％ (17/19),94.7％ (18/19) and 94.7％ (18/19) in the HCC-SR group but 43.1％ (59/137),54.0％ (74/137),59.1％ (81/137) and 66.4％ (91/137) in the non-HCC-SR group respectively,and the differences reached statistical significance (P =0.006,0.003,0.002,and 0.014); (2) The 1-,2-,3-and 5-year postoperative disease-free survival rates were 10.5％ (2/19),5.3％ (1/19),5.3％ (1/19) and 5.3％ (1/19) in the HCC-SR group but 40.1％ (55/137),21.2％ (29/137),12.4％ (17/137) and 4.4％ (6/137) in the non-HCC-SR group respectively,and only the 1-year disease-free survival rate was significantly different (P =0.032); (3) The 1-,2-,3-and 5-year postoperative OS rates were 42.1％ (8/19),10.5％ (2/19),5.3％ (1/19) and 5.3％ (1/19) in the HCC-SR group but 59.1％ (81/137),32.8％ (45/137),19.0％ (26/137) and 6.6％ (9/137) in the non-HCC-SR group,and none of the differences reached statistical significance (P =1.972,0.061,0.200,1.000).Multivariate analysis identified that severity of concomitant liver cirrhosis,levels of alpha fetoprotein (AFP),choice of treatment modality,and type of HCC-SR acted as factors influencing OS.Conclusion Patients with HCC-SR receiving curative hepatectomy have higher postoperative recurrence rates than their non-HCC-SR counterparts,but the two groups have similar postoperative OS rates.OS is influenced by severity of concomitant liver cirrhosis,level of AFP,choice of treatment modality,and type of HCC-SR.