Analysis of short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer

Objective To investigate the short- and long-term prognostic factors for patients with spontaneous rupture and bleeding of primary liver cancer (liver cancer). Methods Clinical data of 167 patients with spontaneous rupture and bleeding of liver cancer admitted to Jiangmen Hospital, Southern Medical University and Nanshan Hospital, Guangdong Medical College between January 2005 and December 2012 were retrospectively analyzed. There were 140 males and 27 females with the average age of (58±7) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Seventy-eight cases were diagnosed with Child-Pugh classification A, 44 with Child-Pugh classification B and 45 with Child-Pugh classification C. According to the tumor, node, metastasis (TNM) stage, 31 cases were in stage Ⅱ, 54 in stage Ⅲ, 73 in stage ⅣA and 9 in stage ⅣB. The 30-d and long-term survival rates were analyzed. The influencing factors of survival rates were analyzed by Cox's proportional hazard regression model. Results The 30-d survival rate was 71.3%, and the 1-, 3- , 5-year accumulative survival rate was 40.1%, 16.5%, 5.4% respectively. Multiviariate Cox's regression analysis revealed that Child-Pugh classification C, hypovolemic shock, number of tumors≥2, TNM stage Ⅲ and conservative therapy were the independent risk factors for 30-d survival rate (HR=9.503, 2.919, 4.760, 0.283, 32.004; P<0.05). Liver cirrhosis, Child-Pugh classification C, total bilirubin (TB)≥34 μmol/L, number of tumors≥2, TNM stage Ⅲ and conservative therapy were the independent risk factors for long-term survival rate (HR=9.167, 5.950, 1.037, 2.821, 0.680, 8.147; P<0.05). Conclusions For patients with spontaneous rupture and bleeding of liver cancer, Child-Pugh classification C, hypovolemic shock, number of tumors≥2, TNM stage Ⅲ and conservative therapy are the independent risk factors for short-term pronosis, whereas liver cirrhosis, Child-Pugh classification C, TB≥34 μmol/L, number of tumors≥2, TNM stage Ⅲ and conservative therapy are the independent risk factors for long-term pronosis. Key words: Liver neoplasms; Rupture; Hepatectomy; Prognosis; Regression analysis