title: Survival outcome of patients with spontaneously ruptured hepatocellular carcinoma treated surgically or by transarterial embolization.
abstract: OBJECTIVE
  To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC).
  
  
  METHODS
  A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm(3)/mL in bloody fluid.
  
  
  RESULTS
  Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4- and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with post-treatment mortality.
  
  
  CONCLUSIONS
  Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE.
authors.affiliation: Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, South Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Jin
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Seoung-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Don Haeng
authors.initials: DH
authors.lastname: Lee
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Soon Gu
authors.initials: SG
authors.lastname: Cho
authors.forename: Yong Sun
authors.initials: YS
authors.lastname: Jeon
authors.forename: Kun Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung-Ik
authors.initials: SI
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ruptured hepatocellular carcinoma; Surgery; Transarterial embolization
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