Abstract:Objective To explore the prognosis of patients with the occult rupture of primary hepatocellular carcinoma（HCC） after elective hepatectomy. Methods A retrospective analysis was performed on the clinical data of 397 HCC patients receiving elective hepatectomy in Heze Municipal Hospital from January 2006 to September 2016. Results There were 31 patients（7.8%） with occult rupture of HCC （ruptured group） and 366 patients （92.2%） without occult rupture of HCC（unruptured group）.The overall survival rates at 1-, 3-and 5-year were 46.7%, 17.8% and 15.2%,respectively in rupture group and were lower than those（84.5%, 53.3% and 47.4%） in unruptured group（P<0.01）. The disease-free survival （DFS） rates at 1-, 3-and 5-year were 22.9%, 15.2%, 5.9%,respectively in ruptured group and were significantly lower than those（71.4%, 40.0%, 35.5%） in unruptured group （P＜0.01）. A total of 26 cases died in ruptured group, 25 cases died of HCC related recurrence, and 1 case died of liver disease during follow-up period. 〖JP2〗Cox regression analysis showed that the non-complete resection （R0） was an independent risk factor for DFS in patients with occult ruptured HCC［RR=5.464, 95%CI （2.070-14.422），P＜0.01］. Conclusion The occult tumor rupture is an important factor for HCC patients' prognosis after undergoing hepatectomy. The patients with occult ruptured HCC receiving non-R0 resection have poor DFS.