title: Prognosis and therapy for ruptured hepatocellular carcinoma: problems with staging and treatment strategy.
abstract: BACKGROUND
  There are no clear criteria established for treating a ruptured hepatocellular carcinoma (HCC). To elucidate the clinical features of affected patients, we examined prognosis and therapy choices.
  
  
  METHODS
  We enrolled 67 patients treated for a ruptured HCC (HCV 44, HBV 5, HBV+HCV 1, alcohol 2, others 15; naïve HCC 34, recurrent 33) from 2000 to 2013, and investigated their clinical background and prognosis.
  
  
  RESULTS
  Median survival time (MST) for all cases was 4 months. For patients who survived for more than 1 year after rupture, the percentages of Child-Pugh C and positive for portal vein tumor thrombosis (PVTT)/extrahepatic metastasis were less than for those who died within 1 year. Child-Pugh classification (A:B:C=14:15:5 vs. 4:9:20, P<0.001) was better, while the percentage of patients with multiple tumors was lower [19/34 (55.9%) vs. 29/33 (87.9%), respectively; P<0.001] in the naïve group. The 1- and 3-year survival rates were better in the naïve as compared to the recurrent group (60.6% and 33.3% vs. 12.6% and 0%, respectively; P<0.01). MST according to modified TNM stage (UICC 7th) calculated after exclusion of T4 factor of rupture, stage I was better than others (22.7 vs. (II) 2.2, (III) 1.2, and (IV) 0.7 months) (P=0.010).
  
  
  CONCLUSIONS
  In patients with a ruptured HCC, especially those with a single tumor, and without decompensated liver cirrhosis and PVTT/extrahepatic metastasis, better prognosis can be expected with curative treatment. The present naïve group included more of such cases than the recurrent group, indicating the effectiveness of curative therapy.
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan. Electronic address: hirage@m.ehime-u.ac.jp.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Tomoe
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Aibiki
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Tomonari
authors.initials: T
authors.lastname: Okudaira
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Toshimori
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Hiroka
authors.initials: H
authors.lastname: Yamago
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Nakahara
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Suga
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Azemoto
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Yasunao
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Department of Radiology, Ehime Prefectural Central Hospital.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Radiology, Ehime Prefectural Central Hospital.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ishimaru
authors.affiliation: Department of Surgery, Ehime Prefectural Central Hospital.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawasaki
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Kasuga-cho 83, Matsuyama, Ehime 790-0024, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000401:mortality* / Q000628:therapy
keywords: Hepatocellular carcinoma; Prognosis; Rupture; Surgical resection; Transcatheter arterial embolization