Risk factor and prediction of spontaneous rupture of Barcelona Clinic Liver Cancer stage A primary hepatocellular carcinoma

doi:10.16139/j.1007-9610.2020.01.009

Abstract

Abstract:

Objective To explore the risk factor and prediction of rupture of Barcelona Clinic Liver Cancer (BCLC) stage A primary hepatocellular carcinoma (HCC). Methods We analyzed retrospectively the clinical data of 25 patients with spontaneous rupture of BCLC stage A HCC between March 2002 and November 2019 in our hospital with 25 patients of HCC without rupture of HCC (rHCC) by random as control. Independent risk factor of rHCC was studied by both univariate and multivariate Logistic regression. Logistic regression model to predict rHCC was studied. Results Multivariate regression analysis identified tumor protrusion from liver surface as independent risk factor associated with BCLC stage A rHCC (OR=38.333, P<0.01). Logistic regression model to predict rHCC was established successfully. Receiver operating characteristic (ROC) curves was set up. The area under the ROC curve was 0.820 with Youden index 0.640, sensitivity 0.720 and specificity 0.920. Conclusions It was shown tumor protrusion from liver surface as an independent risk factor of BCLC stage A rHCC. Logistic regression model could be used to predict effectively the risk of rupture in patients with BCLC stage A HCC.

Key words: Primary hepatocellular carcinoma, Rupture, Risk factor, Logistic model

CLC Number:

R735.7

YE Feng, MA Di, GONG Xiaoyong, YANG Yuchen, CHEN Yongjun. Risk factor and prediction of spontaneous rupture of Barcelona Clinic Liver Cancer stage A primary hepatocellular carcinoma[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 40-44.

Figures/Tables 3

References 22

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项目	病例组（n=25）	对照组（n=25）	P值
年龄（岁）	58.00(21.0)	64.0(14.0)	0.130^b)
性别			0.747^c)
男	19	18
女	6	7
白蛋白（g/L）	32.15±7.50	40.04±4.19	0.142^a)
总胆红素（μmol/L）	23.42±13.03	17.90±8.69	0.160^a)
丙氨酸转氨酶（U/L）	35.50(22.25)	25.00(20.50)	0.050^b)
天冬氨酸转氨酶（U/L）	61.00(49.00)	27.00(16.50)	<0.001^b)
肌酐（μmol/L）	76.00(52.00)	75.00(20.50)	0.233^b)
Child-Pugh分级			0.002^c)
A	10^d)	25
B	7^d)	0
血红蛋白（g/L）	104.00(43.50)	140.00(25.50)	<0.001^b)
血小板（×10⁹/L）	195.92±95.02	132.00±71.06	0.167^a)
凝血功能检查
活化部分凝血活酶时间（s）	31.22±4.13	30.54±3.08	0.464^a)
凝血酶原时间（s）	14.10±1.42	12.12±0.97	0.112^a)
国际标准化比值	1.21±0.12	1.03±0.09	0.212^a)
纤维蛋白原（g/L）	2.80(1.45)	2.40(0.85)	0.031^b)
凝血酶时间（s）	19.00(1.55)	18.60(1.15)	0.571^b)
HCC分级			0.316^c)
<Ⅲ	1^d)	13
≥Ⅲ	3^d)	12
肝硬化			0.001^c)
无	20	8
有	5	17
腹水			0.157^c)
无	18	22
有	7	3
肿瘤位置			0.313^c)
左肝	15	19
右肝	6	5
左右肝交界	1	1
尾状叶	3	0
手术			<0.001^c)
无	18	0
有	7	25

临床参数	单因素分析			多因素分析
临床参数	OR	95%CI	P值	OR	95%CI	P值
年龄	0.968	0.929~1.009	0.129
性别	0.812	0.229~2.882	0.747
甲胎蛋白≥400 μg/L	7.187	1.157~44.651	0.034
HBsAg(+)	1.176	0.281~4.926	0.824
肝硬化	0.118	0.032~0.428	0.001
腹水	2.852	0.643~12.642	0.168
肿瘤位置	1.926	0.865~4.292	0.109
凸出肝表面	29.571	5.466~159.970	<0.001	38.333	5.525~265.981	<0.001
肿瘤最大径≥5 cm	276.000	23.400~3 255.318	<0.001
肿瘤分级	3.250	0.296~35.658	0.335
合并高血压	0.587	0.169~2.048	0.404
合并糖尿病	0.051	0.006~0.445	0.007
TACE史	0.292	0.030~2.851	0.290

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