Abstract
BackgroundSpontaneous rupture is rare complication of hepatocellular carcinoma (HCC) with high mortality rate in cirrhotic cases. The aim of this study was to determine the factors influencing prognosis in cases of spontaneously ruptured HCC and to investigate the outcomes of the treatments employed, especially transcatheter arterial embolization (TAE).MethodsA retrospective multicenter study was conducted in 48 cirrhotic patients with spontaneous rupture of HCC. Conservative treatment was employed in 32 patients (ConT group) and TAE was performed in 16 patients (TAE group).ResultsThe median survival time (MST) in the ConT group was only 13.1 days and the survival rate was extremely poor: 59.4% at 7 days, 37.5% at 14 days, and 6.3% at 30 days. On the other hand, the MST in the TAE group was 244.8 days and the survival rate was 87.5% at 1 month, 56.3% at 3 months, 23.4% at 12 months, and 15.6% at 24 months. According to the results of univariate analyses, factors associated with poor hepatic function and poor suitability for TAE was important determinants of short-term death (less than 3 weeks) among the patients (p < 0.05). On the other hand, among the patients in whom initial TAE was successfully performed (n = 15), a multivariate analysis showed that a maximum tumor size not exceeding 7 cm was the only independent factor determining long-term survival (p = 0.0130).ConclusionDespite the inherent limitations of this retrospective study, TAE appears to be a useful treatment strategy for cirrhotic patients with spontaneous HCC rupture, as it yielded a longer survival period compared with conservative treatment in patients with ruptured HCC. Among the patients with ruptured HCC in whom initial TAE was successfully performed, the maximum tumor size was an important factor influencing survival.
Highlights
Spontaneous rupture is rare complication of hepatocellular carcinoma (HCC) with high mortality rate in cirrhotic cases
Spontaneous rupture was the initial symptom of HCC in 4 patients, while in the remaining 44 patients, the spontaneous rupture of HCC was diagnosed during the follow-up period for liver cirrhosis (LC) or HCC
These results suggest that transcatheter arterial embolization (TAE) is a useful treatment strategy for the spontaneous rupture of HCC and that factors reflecting the background liver function are important factors influencing short-term mortality
Summary
Spontaneous rupture is rare complication of hepatocellular carcinoma (HCC) with high mortality rate in cirrhotic cases. The aim of this study was to determine the factors influencing prognosis in cases of spontaneously ruptured HCC and to investigate the outcomes of the treatments employed, especially transcatheter arterial embolization (TAE). The following treatments have been employed for the treatment of ruptured HCC: emergent hepatic resection, placation or packing, hepatic artery ligation, and transcatheter arterial embolization (TAE) [918]. Patients with advanced HCC tend to have poor hepatic function as a result of chronic hepatitis or liver cirrhosis. A better understanding of the disease, wider recognition of this potential complication, improved methods of assessing liver function preoperatively, and less invasive methods of hemostasis may contribute to improved survival in cases of ruptured HCC
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