title: Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study.
abstract: BACKGROUND
  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).
  
  
  METHODS
  A 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).
  
  
  RESULTS
  The 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).
  
  
  CONCLUSIONS
  Despite 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.
authors.affiliation: Gastroenterology Division, Yokohama City University Graduate School of Medicine, Yokohama, Japan. hkirikos@med.yokohama-cu.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Hironori
authors.initials: H
authors.lastname: Mawatari
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Takuma
authors.initials: T
authors.lastname: Higurashi
authors.forename: Kento
authors.initials: K
authors.lastname: Imajo
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Atsukawa
authors.forename: Aya
authors.initials: A
authors.lastname: Sawabe
authors.forename: Akira
authors.initials: A
authors.lastname: Kanesaki
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Norio
authors.initials: N
authors.lastname: Ueno
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome