title: Transcatheter arterial chemoembolization confers survival benefit in patients with a spontaneously ruptured hepatocellular carcinoma.
abstract: OBJECTIVE
  Spontaneous rupture causing a hemoperitoneum is a life-threatening complication of hepatocellular carcinoma (HCC). The aim of this study was to document clinical features and prognostic factors in patients with a ruptured HCC.
  
  
  METHODS
  The medical records of 1412 patients with HCC admitted to a single tertiary medical center from January 2000 to August 2010 were reviewed. The clinical features, treatment modalities, and outcomes were collected. Univariate and multivariate analyses were carried out to analyze the factors affecting survival.
  
  
  RESULTS
  Thirty-five of 1412 patients diagnosed with a ruptured HCC were included. The median survival time was 59 days. Transcatheter arterial chemoembolization (TACE) was performed in 24 patients and 11 patients were managed conservatively. The 24 patients who received TACE achieved hemostasis without complications. The 30-day survival was related to better Child-Pugh class, higher hemoglobin level, lower creatinine level, and TACE in patients with a ruptured HCC. Multivariate analysis showed that patients who received TACE [odds ratio (OR), 0.076; P=0.020] or those with higher hemoglobin level (OR, 0.626; P=0.011) had a better chance of survival. The 30-day survival rate in a patient who received TACE was 83.3%. In the TACE group, the 30-day survival was independently associated with a higher hemoglobin level (OR, 0.609; P=0.036).
  
  
  CONCLUSIONS
  TACE is a minimally invasive treatment that has a high success rate for hemostasis. TACE increased the 30-day survival in patients with a ruptured HCC. However, survival rates in patients with lower hemoglobin levels, resulting in a large amount of bleeding, remained poor regardless of successful TACE.
authors.affiliation: Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
authors.forename: Jong Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: June Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Dong-Hoon
authors.initials: DH
authors.lastname: Oh
authors.forename: Yun Hyuk
authors.initials: YH
authors.lastname: Yim
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins