Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study.
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.
Kirikoshi
Hiroyuki
H
Gastroenterology Division, Yokohama City University Graduate School of Medicine, Yokohama, Japan. hkirikos@med.yokohama-cu.ac.jp
Saito
Satoru
S
Yoneda
Masato
M
Fujita
Koji
K
Mawatari
Hironori
H
Uchiyama
Takashi
T
Higurashi
Takuma
T
Imajo
Kento
K
Sakaguchi
Takashi
T
Atsukawa
Kazuhiro
K
Sawabe
Aya
A
Kanesaki
Akira
A
Takahashi
Hirokazu
H
Abe
Yasunobu
Y
Inamori
Masahiko
M
Kobayashi
Noritoshi
N
Kubota
Kensuke
K
Ueno
Norio
N
Nakajima
Atsushi
A
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