Apolline Commin, Chloé Metivier, Manon Allaire, Jean Lubrano, Amandine Claudinot, Audrey Coilly, Marc-Antoine Allard, Charles Roux, Olivier Scatton, Jean Charles Nault, Olivier Sutter, Nathalie Ganne-Carrié, Thuy Vi Ngo, Valérie Le Goff, Zeineb Ben Ali, Husni Tedlaouti, Josephine Papin, Marion Habireche, Louise Lebedel, Claire Pérignon, Thông Dao, Rémy Morello, Isabelle Ollivier-Hourmand
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This study aims to evaluate whether the initial hemostatic approach influences early prognosis and facilitates further treatment of HCC.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retroprospective multicentric cohort included patients with SRHCC since 2008. Cox and Kaplan–Meier models analysed factors associated with overall survival (OS).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>112 patients with SRHCC were included. Hemostatic treatment was administered in 54.4% of cases (83.6% embolization, 9.8% surgery and 6.6% embolization plus surgery). The 30-day mortality rate was 28.6%. Factors associated with 30-day mortality included ALBI score > 2 (HR = 4.23; <i>p</i> = 0.001), shock (HR = 2.37; <i>p</i> = 0.029), acute kidney injury (HR = 4.40; <i>p</i> = 0.003), and BCLC stage C/D (HR = 14.29; <i>p</i> = 0.010). Early hemostatic intervention was associated with improved 30-day survival (HR = 0.42; <i>p</i> = 0.033). Palliative care was initiated in 27% of patients (10% after embolization and 17% upon admission). One-third of patients received subsequent HCC treatment after a median of 84 days [IQR: 39–176] (55.3% surgery and 18.4% systemic therapy). Among these, 63% (<i>n</i> = 24) had undergone early hemostatic treatment.</p>\n \n <p>The one-year OS rate was 39.3%, the median follow-up duration was 136 days (95% CI: 20.3–739.5), and the median OS was 6.6 ± 4.1 months (95% CI: 0–14.8). 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引用次数: 0
摘要
肝细胞癌自发性破裂（SRHCC）是一个关键的临床挑战，早期止血往往难以实现，后续治疗策略的数据有限。本研究旨在评估初始止血入路是否会影响HCC的早期预后并促进进一步治疗。方法：该回顾性多中心队列纳入2008年以来的SRHCC患者。Cox和Kaplan-Meier模型分析了与总生存期（OS）相关的因素。结果：纳入112例SRHCC患者。止血治疗占54.4%，其中栓塞治疗占83.6%，手术治疗占9.8%，栓塞加手术治疗占6.6%。30天死亡率为28.6%。与30天死亡率相关的因素包括ALBI评分bbbb2 （HR = 4.23, p = 0.001）、休克（HR = 2.37, p = 0.029）、急性肾损伤（HR = 4.40, p = 0.003）和BCLC分期C/D （HR = 14.29, p = 0.010）。早期止血干预与30天生存率提高相关（HR = 0.42; p = 0.033）。27%的患者开始了姑息治疗（10%在栓塞后，17%在入院时）。三分之一的患者在中位84天后接受后续HCC治疗[IQR: 39-176]（55.3%的患者接受手术治疗，18.4%的患者接受全身治疗）。其中，63% （n = 24）接受了早期止血治疗。1年OS率为39.3%，中位随访时间为136天（95% CI: 20.3-739.5），中位OS为6.6±4.1个月（95% CI: 0-14.8）。肝细胞癌破裂后延迟治疗可显著改善OS （HR = 0.35; 95% CI: 0.20-0.61; p）结论：我们的研究结果表明，在补偿良好的肝细胞癌自发破裂患者中，早期止血治疗可能是有益的。试验注册：NCT06505291。
Early Hemostatic Treatment Could Improve 30-Day Survival After Spontaneous Rupture of Hepatocellular Carcinoma
Introduction
Spontaneous rupture of hepatocellular carcinoma (SRHCC) presents a critical clinical challenge, with early haemostasis often difficult to achieve and limited data available on subsequent treatment strategies. This study aims to evaluate whether the initial hemostatic approach influences early prognosis and facilitates further treatment of HCC.
Methods
This retroprospective multicentric cohort included patients with SRHCC since 2008. Cox and Kaplan–Meier models analysed factors associated with overall survival (OS).
Results
112 patients with SRHCC were included. Hemostatic treatment was administered in 54.4% of cases (83.6% embolization, 9.8% surgery and 6.6% embolization plus surgery). The 30-day mortality rate was 28.6%. Factors associated with 30-day mortality included ALBI score > 2 (HR = 4.23; p = 0.001), shock (HR = 2.37; p = 0.029), acute kidney injury (HR = 4.40; p = 0.003), and BCLC stage C/D (HR = 14.29; p = 0.010). Early hemostatic intervention was associated with improved 30-day survival (HR = 0.42; p = 0.033). Palliative care was initiated in 27% of patients (10% after embolization and 17% upon admission). One-third of patients received subsequent HCC treatment after a median of 84 days [IQR: 39–176] (55.3% surgery and 18.4% systemic therapy). Among these, 63% (n = 24) had undergone early hemostatic treatment.
The one-year OS rate was 39.3%, the median follow-up duration was 136 days (95% CI: 20.3–739.5), and the median OS was 6.6 ± 4.1 months (95% CI: 0–14.8). Delayed HCC treatment following rupture significantly improved OS (HR = 0.35; 95% CI: 0.20–0.61; p < 0.001), particularly when surgery was performed (p < 0.0001).
Conclusion
Our results suggest that early hemostatic treatment could be beneficial after spontaneous rupture of HCC in well compensated patients.
期刊介绍：
Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.
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