Risk factors and surgical outcomes for spontaneous rupture of BCLC stages A and B hepatocellular carcinoma: A case-control study

Table 1 Comparison of clinical data between patients with and without spontaneous rupture of hepatocellular carcinoma n (%)

Variable	Case group (n = 89)	Control group (n = 171)	P value
Age (yr)	48.5 ± 11.2	50.3 ± 11.5	0.215
Sex (M/F)	83/6	151/20	0.206
Diabetes			0.626
Yes	3	167
No	86	4
Hypertension			0.030
Yes	9	6
No	80	165
HBsAg status			0.195
Positive	82	151
Negative	7	20
Liver cirrhosis			< 0.001
Yes	73	99
No	16	72
Child-Pugh classification			0.148
A	84	159
B	5	12
Tumor BCLC classification			0.653
A	31	68
B	58	103
Tumor size (cm)	8.1 ± 3.1	6.5 ± 4.2	0.001
Tumor location1			< 0.001
Segment I	2	1
Segments IIand III	20	16
Segment VI	47	52
Segments IV,V,VII and VIII	20	102
Tumor protrudes from liver surface			0.138
Yes	45	70
No	44	101
Satellite nodule(s)			0.288
Yes	29	45
No	60	126
AFP (ng/mL)	138.5 (1.8, 20181.0)	73.8 (2.4, 224492.0)	0.102
WBC (× 109/L)	5.7 ± 2.5	5.9 ± 1.8	0.381
PLT (× 109/L)	154.7 ± 71.8	147.0 ± 61.3	0.112
Total bilirubin (umol/L)	21.67 ± 3.25	13.57 ± 4.33	0.104
Albumin (g/L)	39.18 ± 3.16	40.52 ± 3.45	0.624
ALT (IU/L)	55.5 ± 49.0	60.5 ± 51.0	0.447
PT (s)	13.0 ± 1.5	13.2 ± 1.5	0.286
BUN (mmol/L)	6.01 ± 0.39	5.93 ± 1.01	0.342
Cr (umol/L)	71.65 ± 12.51	74.72 ± 19.46	0.179
Types of liver resection			0.199
Minor ≤ 3 liver segments	70	120
Major ≥ 4 liver segments	19	51
Radical resection			0.011
Yes	80	163
No	9	8
Inflow blood occlusion time (min)	15.4 ± 6.9	15.4 ± 7.0	0.993
Blood loss (mL)	550 (300, 3200)	200 (50, 2000)	0.011
Blood transfusion (yes/no)	38/51	29/142	< 0.001
Tumor grade (Iand II/III and IV)2	3/86	20/151	0.025
30-d mortality	1 (1.1)	1 (0.6)	0.079

¹Couinaud’s classification to segment the liver;

²Edmondson-Steiner classification. HCC: Hepatocellular carcinoma; BCLC: Barcelona Clinic Liver Cancer; AFP: Alpha-fetoprotein; WBC: White blood cell; PLT: Platelet; ALT: Alanine aminotransferase; PT: Prothrombin time; BUN: Blood urea nitrogen; Cr: Creatinine.

Table 2 Multivariate analysis of variables associated with spontaneous rupture of hepatocellular carcinoma

Variable	HR	95%CI for HR	P value
Hypertension			0.004
Yes	7.38	1.91-28.58
No	1
Liver cirrhosis			< 0.001
Yes	6.04	2.83-12.88
No	1
Tumor size			0.184
≥ 10 cm	1.62	0.80-3.31
< 10 cm	1
Tumor locaction1			< 0.001
Segments II, III and VI	5.03	2.70-6.37
Other segments	1

¹Couinaud’s classification to segment the liver. HCC: Hepatocellular carcinoma; HR: Hazard ratio; CI: Confidence interval.

Table 3 Predictors of survival on multivariate analysis using a Cox regression model in patients with spontaneous rupture of hepatocellular carcinoma

Variable	Overall survival			Disease-free survival
	HR	95%CI	P value	HR	95%CI	P value
Age	1.01	0.99-1.03	0.348	1.02	0.99-1.05	0.097
Liver cirrhosis (yes vs no)	1.05	0.55-2.03	0.878	1.29	0.54-3.09	0.566
BCLC stage (stage A vs stage B)	1.35	0.60-3.06	0.470	1.13	0.41-3.07	0.817
Tumor size	0.96	0.88-1.06	0.456	0.92	0.81-1.05	0.235
Tumor location	1.02	0.59-1.76	0.936	1.24	0.64-2.42	0.524
Satellite nodule(s) (yes vs no)	0.77	0.46-1.27	0.299	0.76	0.39-1.47	0.413
Blood loss	1.00	1.00-1.00	0.085	1.00	1.00-1.00	0.940
Blood transfusion (yes vs no)	1.00	0.51-1.98	0.994	1.12	0.49-2.59	0.788
Radical resection (yes vs no)	0.32	0.08-0.61	0.015	0.12	0.01-0.73	0.002

HCC: Hepatocellular carcinoma; HR: Hazard ratio; CI: Confidence interval; BCLC: Barcelona clinic liver cancer.