Peritoneal Carcinomatosis Risk and Long-Term Survival Following Hepatectomy for Spontaneous Hepatocellular Carcinoma Rupture: Results of a Multicenter French Study (FRENCH-AFC).

Aged Carcinoma, Hepatocellular / complications Female France Hepatectomy / mortality Humans Italy Liver Neoplasms / complications Male Middle Aged Neoplasm Recurrence, Local / etiology Peritoneal Neoplasms / etiology Prognosis Retrospective Studies Risk Factors Rupture, Spontaneous / complications Survival Analysis Treatment Outcome

Journal

Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840

Informations de publication

Date de publication:
Sep 2020
Historique:
received: 22 11 2019
pubmed: 15 4 2020
medline: 7 4 2021
entrez: 15 4 2020
Statut: ppublish

Résumé

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). The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM. We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012. 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. 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.

Sections du résumé

BACKGROUND 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 OBJECTIVE
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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1245/s10434-020-08442-5 PMID: 32285281
pubmed: 32285281
doi: 10.1245/s10434-020-08442-5
pii: 10.1245/s10434-020-08442-5
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

3383-3392

Références

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Auteurs

Edouard Roussel (E)

Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen Cedex, France.

Michael Bubenheim (M)

Department of Biostatistics, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France.

Yves-Patrice Le Treut (YP)

Department of General Surgery and Liver Transplantation, APHM, Hôpital de la Conception, Marseille University Hospital, Marseille, France.

Alexis Laurent (A)

Department of Digestive, Hepatobiliary, Pancreatic Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.

Astrid Herrero (A)

Department of Digestive Surgery, Hôpital Saint Eloi, Montpellier University Hospital, Montpellier, France.

Fabrice Muscari (F)

Department of Digestive Surgery and Liver Transplantation, Hôpital Rangueil, Toulouse University Hospital, Toulouse, France.

Jean-Yves Mabrut (JY)

Department of Digestive Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Lyon University Hospital, Lyon, France.

Eric Savier (E)

Department of Digestive Surgery and Liver Transplantation, Hôpital La Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France.

Emmanuel Boleslawski (E)

Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Nord-de-France University Hospital, Lille, France.

Ahmet Ayav (A)

Department of HPB Surgery, Nancy University Hospital, Nancy, France.

Emilie Lermite (E)

Department of Digestive Surgery, Angers University Hospital, Angers, France.

Alexandre Doussot (A)

Department of Digestive Surgery, Dijon University Hospital, Dijon, France.

Jean-Marc Regimbeau (JM)

Department of Digestive Surgery, Hôpital Nord, Amiens University Hospital, Amiens, France.

Romain Riboud (R)

Department of Emergency and Digestive Surgery, Grenoble University Hospital, Grenoble, France.

Daniel Cherqui (D)

Department of Hepatobiliary and Liver Transplantation, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France.

Lilian Schwarz (L)

Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen Cedex, France. lilian.SCHWARZ@gmail.com.
Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie Univ, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Rouen, France. lilian.SCHWARZ@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du foie › Tumeurs du foie › Carcinome hépatocellulaire › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Régions géographiques › Europe › France › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Hépatectomie › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Régions géographiques › Europe › Italie › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du foie › Tumeurs du foie › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Récidive tumorale locale › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies du péritoine › Tumeurs du péritoine › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Diagnostic › Pronostic › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Rupture spontanée › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Analyse de survie › Peritoneal Carcinomatosis Risk and Long-Term...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Peritoneal Carcinomatosis Risk and Long-Term...