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Sempokuya T, Wong LL. Do we really need a standardized approach to spontaneously ruptured hepatocellular carcinoma? Hepatobiliary Surg Nutr 2024; 13:191-193. [PMID: 38322214 PMCID: PMC10839716 DOI: 10.21037/hbsn-23-625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/28/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Tomoki Sempokuya
- Division of Gastroenterology and Hepatology, Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Linda L. Wong
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
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Zhao ZH, Jiang C, Wu QY, Lv GY, Wang M. Nomogram for Estimation of Acute Liver Failure Risk in Spontaneous Ruptured Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:2223-2237. [PMID: 38107544 PMCID: PMC10725690 DOI: 10.2147/jhc.s438346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Acute liver failure (ALF) is a severe complication of spontaneous ruptured hepatocellular carcinoma (SRHCC) that requires accurate prediction for effective treatment strategies. We aimed to develop a predictive nomogram to estimate the risk of ALF in patients with SRHCC undergoing treatment. Patients and Methods We performed a retrospective analysis of historical data from 284 patients diagnosed with SRHCC at the First Hospital of Jilin University over the past decade. Variables were selected through univariate and multivariate logistic regression analyses, and a predictive nomogram was constructed. We evaluated its predictive accuracy against the Child-Pugh Score, R.MELD, and ALBI by assessing discrimination, calibration, and net clinical benefit. Results Among the 284 patients, 65 developed ALF. The risk factors identified for model development included largest tumor size (LTS), platelet counts, prolonged prothrombin time, and elevated serum α-fetoprotein levels. The nomogram exhibited high accuracy in predicting ALF risk with a C-index of 0.91 (0.87-0.95). The Delong test showed a significant difference between the nomogram and the other three models (p<0.05). The calibration curve for the nomogram fit well, and the decision curve analysis revealed superior net benefit. The optimal cut-off point for the nomogram was determined to be 40, yielding sensitivity, specificity, positive predictive value, and negative predictive value of 83.10%, 87.20%, 65.90% and 94.60%, respectively. Conclusion The nomogram we developed provides an optimized tool for predicting ALF in SRHCC patients. Its application can help determine individual patient's risk of ALF, enabling more rational and personalized treatment strategies.
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Affiliation(s)
- Zhi-Hao Zhao
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Chao Jiang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Qing-Yuan Wu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
| | - Meng Wang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, the First Hospital of Jilin University, Changchun, Jilin Province, People’s Republic of China
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Cali J, Chevallier O, Guillen K, Latournerie M, Mazit A, Aho-Glélé LS, Loffroy R. Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes. J Pers Med 2023; 13:1581. [PMID: 38003896 PMCID: PMC10672353 DOI: 10.3390/jpm13111581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study was to report the outcomes of cyanoacrylate-lipiodol embolization for rHCC. We retrospectively reviewed the files of the 16 patients (14 males; mean age, 72 years) who underwent emergency cyanoacrylate-lipiodol STAE at a single center in 2012-2023 for spontaneous rHCC. All 16 patients had subcapsular HCC and abundant hemoperitoneum. The technical success rate was 94% (15/16). Day 30 mortality was 19%; the three patients who died had severe hemodynamic instability at admission; one death was due to rebleeding. Liver enzyme levels returned to baseline by day 30. No rebleeding was recorded during the median follow-up of 454 days in the 10 patients who were alive with available data after day 30. Larger prospective studies with the collection of longer-term outcomes are needed to assess our results supporting the safety and effectiveness of cyanoacrylate-lipiodol STAE for rHCC. Randomized trials comparing this mixture to other embolic agents should be performed.
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Affiliation(s)
- Jory Cali
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France; (J.C.); (O.C.); (A.M.)
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France; (J.C.); (O.C.); (A.M.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Kévin Guillen
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France; (J.C.); (O.C.); (A.M.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
| | - Marianne Latournerie
- Department of Gastroenterology and Hepatology, Francois-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France;
| | - Amin Mazit
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France; (J.C.); (O.C.); (A.M.)
| | - Ludwig Serge Aho-Glélé
- Department of Epidemiology, Statistics and Clinical Research, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France;
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21000 Dijon, France; (J.C.); (O.C.); (A.M.)
- ICMUB Laboratory, UMR CNRS 6302, University of Burgundy, 9 Avenue Alain Savary, 21000 Dijon, France
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Romero-Gutiérrez M, Pascual S, Márquez L, Gómez-Rubio M, Miquel M, Alarcón C, Ferrer T, Aracil C, Horta D, Latorre R, González Santiago J, Bernal V, Fernández C, Piqueras B, Gutiérrez ML, Martín A, Morillas J, Morales D, Blanco S, Rendón P, Chico I, Testillano M, Delgado C, Matilla A, Gómez Rodríguez R. Spontaneously ruptured hepatocellular carcinoma on non-cirrhotic liver: A prospective case series. GASTROENTEROLOGIA Y HEPATOLOGIA 2023:S0210-5705(23)00395-3. [PMID: 37633519 DOI: 10.1016/j.gastrohep.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND AND AIMS Spontaneous ruptured hepatocellular carcinoma is an uncommon complication, and there are scarce data about non-cirrhotic patients. Tumor treatment is not standardized and the risk of peritoneal dissemination is unclear. AIM we analyzed the treatment and survival in patients with rHCC on non-cirrhotic liver. METHODS One hundred and forty-one non-cirrhotic patients with hepatocellular carcinoma diagnosed by histology were included in a multicenter prospective registry (2018-2022). Seven of them (5%) presented with hemoperitoneum due to spontaneous rupture. RESULTS Liver disease was associated in three patients (42.9%). A single nodule was detected in three cases (42.9%). One patient had vascular invasion and none extrahepatic spread. Initial hemostatic therapy and sequential treatment was individualized. Patients with single nodule were treated: resection (one case) with recurrence at 4 months treated with TACE and sorafenib. TACE/TAE followed by surgery (two cases) one in remission 43 months later, the other had liver recurrence at 18 months and was transplanted. Patients with multiple lesions were treated: TAE/emergency surgery and subsequent systemic therapy (two cases), one received lenvatinib (1-year survival) and the other sorafenib (5-month survival). TAE and surgery with subsequent systemic therapy (one case). Initial hemostatic surgery, dying on admission (one case). No patient developed intraperitoneal metastasis. All patients with multiple lesions died by tumor. The 3-year survival rate was 42.9%. CONCLUSIONS Initial hemostasis was achieved in all patients by TAE/TACE or surgery. Subsequent treatment was individualized, based on tumor characteristics, regardless of rupture. Long-time remission could be achieved in single nodule patients.
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Affiliation(s)
| | - Sonia Pascual
- Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Laura Márquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Teresa Ferrer
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carles Aracil
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Diana Horta
- Hospital Universitario Mútua de Terrassa, Barcelona, Spain
| | - Raquel Latorre
- Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | | | - Vanesa Bernal
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Ana Martín
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | - Sonia Blanco
- Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | | | - Ana Matilla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Spontaneously Ruptured Hepatocellular Carcinoma: Computed Tomography-Based Assessment. Diagnostics (Basel) 2023; 13:diagnostics13061021. [PMID: 36980330 PMCID: PMC10047024 DOI: 10.3390/diagnostics13061021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/10/2023] Open
Abstract
Spontaneously ruptured hepatocellular carcinoma (SRHCC) is an uncommon and life-threatening complication in patients with hepatocellular carcinoma (HCC). It is usually associated with chronic liver disease and has a poor prognosis with a high mortality rate during the acute phase. SRHCC can cause a severe and urgent condition of acute abdomen disease and requires a correct diagnosis to achieve adequate treatment. Clinical presentation is related to the presence of hemoperitoneum, and abdominal pain is the most common symptom (66–100% of cases). Although the treatment approach is not unique, trans-arterial (chemo)embolization (TAE/TACE) followed by staged hepatectomy has shown better results in long-term survival. A multi-phase contrast-enhanced CT (CECT) scan is a pivotal technique in the diagnosis of SRHCC due to its diagnostic accuracy and optimal temporal resolution. The correct interpretation of the main CT findings in SRHCC, such as active contrast extravasation and the sentinel clot sign, is fundamental for a prompt and correct diagnosis. Furthermore, CT also plays a role as a post-operative control procedure, especially in patients treated with TAE/TACE. Therefore, a multi-phase CECT scan should be the diagnostic tool of choice in SRHCC since it suggests an immediate need for treatment with a consequent improvement in prognosis.
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