1. Peritoneal Carcinomatosis Risk and Long-Term Survival Following Hepatectomy for Spontaneous Hepatocellular Carcinoma Rupture: Results of a Multicenter French Study (FRENCH-AFC).
- Author
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Roussel E, Bubenheim M, Le Treut YP, Laurent A, Herrero A, Muscari F, Mabrut JY, Savier E, Boleslawski E, Ayav A, Lermite E, Doussot A, Regimbeau JM, Riboud R, Cherqui D, and Schwarz L
- Subjects
- Aged, Female, France, Hepatectomy mortality, Humans, Italy, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Rupture, Spontaneous complications, Rupture, Spontaneous mortality, Rupture, Spontaneous surgery, Survival Analysis, Treatment Outcome, Carcinoma, Hepatocellular complications, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular surgery, Liver Neoplasms complications, Liver Neoplasms mortality, Liver Neoplasms surgery, Neoplasm Recurrence, Local etiology, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local therapy, Peritoneal Neoplasms etiology, Peritoneal Neoplasms mortality, Peritoneal Neoplasms surgery
- Abstract
Background: Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM)., Objectives: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM., Methods: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012., Results: Overall, 135 patients were included in this study. The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months. At last follow-up, recurrences were observed in 65.1% of patients (n = 88). The overall rate of PM following ruptured HCC was 12% (n = 16). Surgical management of PM was performed for six patients, with a median OS of 36.6 months. An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence. No risk factor for PM was observed., Conclusion: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC. A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide.
- Published
- 2020
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