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Objective:To explore the risk factors of spontaneous rupture of hepatocellular carcinoma (HCC), and to analyze the prognosis of transcatheter arterial embolization (TAE) in the treatment of spontaneous rupture of HCC.Methods:From January 2008 to December 2018, at Tianjin Third Central Hospital, 126 patients diagnosed with spontaneous rupture of HCC (spontaneous rupture group) and in the same period 252 patients diagnosed as HCC without rupture (non-spontaneous rupture group) were retrospectively selected. Independent sample t test, Mann-Whitney U test and chi-square test were used to compare the general data, laboratory test results and imaging results between spontaneous rupture group and non-spontaneous rupture group. Multivariate logistic regression was used to analyze the independent risk factors of spontaneous rupture of HCC. Kaplan-Meier method and log-rank test were used for survival analysis of 92 patients treated with TAE and 31 patients treated with conservative treatment in patients with spontaneous rupture of HCC, and multivariate Cox proportional hazard regression was used to analyze the independent prognostic factors of patients treated with TAE. Results:The proportions of tumor maximum diameter ≥5 cm, tumors mainly located in segment Ⅱ, Ⅲ, Ⅳ and Ⅵ of the liver, tumors protruding height from the surface of liver ≥1 cm, liver cirrhosis and portal vein thrombosis (PVT) in spontaneous rupture group were all higher than those in non-spontaneous rupture group (46.8%, 59/126 vs. 35.7%, 90/252; 61.1%, 77/126 vs. 46.0%, 116/252; 73.0%, 92/126 vs. 18.7%, 47/252; 81.7%, 103/126 vs. 69.0%, 174/252; 20.6%, 26/126 vs. 11.5%, 29/252), and the level of fibrinogen is lower than that in non-spontaneous rupture group ((3.07 ±1.38) g/L vs. (3.92±1.13) g/L), and the differences were statistically significant ( χ2=4.343, 7.644, 106.780, 6.918 and 5.628, t=-3.276, all P<0.05). The results of multivariate logistic regression analysis showed that the location of tumors in segment Ⅱ, Ⅲ, Ⅳ, Ⅵ of the liver, the height of tumors protruding from the surface of liver ≥1 cm, liver cirrhosis and the fibrinogen was lower than the lower limit of the reference value were independent risk factors of spontaneous rupture of HCC (odds ratio ( OR)=1.354, 5.726, 1.152, 1.892; 95% confidence interval ( CI) 1.062 to 2.008, 1.049 to 19.575, 1.016 to 1.895, 1.267 to 3.346; all P<0.05). Among 92 patients with spontaneous rupture of HCC treated with TAE, the TAE technical success rate and clinical success rate were 100.0% (92/92) and 93.5% (86/92), respectively. Thirty-one patients received conservative treatment. The median survival time of the patients treated with TAE was 243 d (38 d, 377 d), which was about 10 times that of the patients who accepted conservative treatment (23 d (9 d, 51 d)). The 1-month, 3-month, 6-month, 1-year and 3-year survival rates of the patients treated with TAE were 72.8%, 50.8%, 46.0%, 31.1% and 13.6%, respectively, and those of patients who accepted conservative treatment were 25.8%, 17.2%, 11.5%, 5.7% and 0, respectively; and the differences in survival rates between the two groups were statistically significant ( χ2=34.606, P<0.01). Log-rank test analysis showed that initial hemoglobin <60 g/L, C grade of liver function, total bilirubin (TBil)≥50 μmol/L, complicated with portal vein tumor thrombus, hepatic lobe embolism during TAE, and tumor maximum diameter ≥10 cm were all correlated with poor survival rates of patients with spontaneous rupture of HCC after TAE ( χ2=3.752, 4.146, 22.318, 4.087, 5.685 and 7.893, all P<0.05). The results of multivariate Cox proportional hazard regression analysis showed that TBil ≥ 50 μmol/L, hepatic lobe embolism during TAE, and tumor maximum diameter ≥10 cm were independent factors of poor prognosis of spontaneous rupture of HCC treated with TAE ( OR=25.873, 8.415, 18.620; 95% CI 4.916 to 126.005, 1.136 to 27.319, 2.754 to 84.368; all P<0.05). Conclusions:In HCC patients with tumors located in segments Ⅱ, Ⅲ, Ⅳ and Ⅵ of the liver, the height of tumors protruding from the surface of liver ≥1 cm, liver cirrhosis or the fibrinogen is lower than the lower limit of the reference value, close attention should be paid to the risk of spontaneous tumor rupture. TAE is an effective treatment for acute spontaneous rupture of HCC, and the prognosis of patients treated with TAE is better than that of patients receiving conservative treatment. However, patients with TBil ≥50 μmol/L, hepatic lobe embolism during TAE and tumor maximum diameter ≥10 cm have a poor prognosis after TAE treatment.
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Objective To analyze the efficacy and complications of interventional treatment in hepatic hemangiomas with poor blood supply,and to explore the mode of treatment.Methods From May 2013 to October 2016,at Tianjin Third Central Hospital,82 patients with hepatic hemangiomas with poor blood supply were enrolled and divided into intervention group,puncture group and combination group.Conventional hepatic artery intubation was performed in intervention group,using a microcatheter to superselect to hemangioma and injecting pingyangmycin-lipiodol emulsion into the tumor of hemangioma.Patients of puncture group underwent the ultrasound-guided percutaneous liver puncture,and the pingyangmycin-lipiodol emulsion was injected into the tumor.The patients of combination group first received intervention treatment,and the pingyangmycin-lipiodol emulsion were injected again into the tumor area lacking of iodized oil deposition through percutaneous transhepatic puncture.After treatment,the complications and clinical efficacy of patients in three groups were evaluated and the reasons of patients lost to follow-up were analyzed.The analysis of variance,Chi-square test and Fisher's exact test were performed for statistical analysis.For patients lost to follow up,intention-to-treat (ITT) analysis and per protocol (PP) analysis were used.Results Among 82 patients with hepatic hemangiomas with poor blood supply,there were 27 in intervention group,24 in puncture group and 31 in combination group.Seven patients developed serious complications such as liver failure.At three months after the treatment,the overall efficacy of combination group (20.9％,9/31) was higher than that of intervention group (7.4％,2/27) and puncture group (4.2 ％,1/24),and the differences were statistically significant (x2 =6.296,P =0.014;x2 =5.622,P =0.031).At six months after the treatment,the overall efficacy of combination group (ITT analysis 70.3 ％,26/37;PP analysis 71.0 ％,22/31) was still higher than that of intervention group (40.9％,9/22) and puncture group (7/18),and the differences were statistically significant (ITT analysis x2 =4.929 and 4.969,PP analysis x2 =4.789 and 4.851;all P＜0.05).At twelve months after the treatment,a total of 41 patients of three group were lost.Among them,the patients with ineffective treatment by clinical effect evaluation accounted for 63.4％ (26/41),which was higher than those with significantly effective treatment (12.2 ％,5/41) and those with effective treatment (24.4 ％,10/41),and the differences were statistically significant (x2=22.873 and 12.676,both P＜0.01).Conclusions The efficacy of the interventional treatment alone for hepatic hemangiomas with poor blood supply is poor and the complications should be considered when selecting the appropriate treatment methods.
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Objective To analyze the impact of the differences in blood supply to hepatic hemangiomas on interventional treatment effectiveness and complications.Methods A retrospective study was conducted on 322 patients with liver hemangiomas treated from January 2008 to December 2015 in Tianjin Third Central Hospital.The hemangiomas were diagnosed and classified into 3 groups according to the blood supply to the hemangioma:the rich blood supply group (n =128),the moderate blood supply group (n =104) and the poor blood supply group (n =90).The hemangiomas were embolized via the hepatic artery,and the therapeutic effect and complication were compared and analyzed among the 3 different groups.The mean follow-up was 12 months.Results The therapeutic effect of hepatic artery embolization was optimal for the rich blood supply group in the first 3-months of follow-up (the significant efficiency,effective rates were 18.8％ and 35.2％ respectively).There was no significant difference between the rich blood supply group and the moderate blood supply group at 12th month follow-up.The treatment effect on the poor blood supply group was significantly worse than the other two groups on follow-up.Complications after treatment occurred most commonly in the rich blood supply group and it was the least common in the poor blood supply group (the incidence rates were 43.8％,36.6％ and 8.9％ respectively).However,severe post-treatment complications were apparently more common in the poor blood supply group than the other two groups.Conclusions The therapeutic effects of transcatheter arterial embolization on hepatic hemangioma can differ because of the diversity in blood supply.In clinical practice,attention should be paid to the proper choice of treatment according to the blood supply to the lesion.Serious complications can occur after treatment.