title: Prognostic factors of spontaneously ruptured hepatocellular carcinoma.
abstract: OBJECTIVE
  To evaluate the prognostic factors in patients with spontaneously ruptured hepatocellular carcinoma (HCC).
  
  
  METHODS
  Seventy-nine patients experiencing spontaneous rupture of HCC between April 2004 and August 2014 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. The statistical methods used in this work included univariate analysis, Kaplan-Meier survival analysis with log-rank tests, and multivariate analysis using a Cox regression hazard model.
  
  
  RESULTS
  Of the 79 patients with HCC rupture, 17 (21.5%) underwent surgery, 32 (40.5%) underwent transarterial embolization (TAE), and 30 (38%) received conservative treatment. The median survival time was 125 d, and the mortality rate at 30 d was 27.8%. Multivariate analysis revealed that lesion length (HR = 1.46, P < 0.001), lesion number (HR = 1.37, P = 0.042), treatment before tumor rupture (HR = 4.36, P = 0.019), alanine transaminase levels (HR = 1.0, P = 0.011), bicarbonate levels (HR = 1.18, P < 0.001), age (HR = 0.96, P = 0.026), anti-tumor therapy during the follow-up period (HR = 0.21, P = 0.008), and albumin levels (HR = 0.89, P = 0.010) were independent prognostic factors of survival after HCC rupture. The Barcelona-Clinic Liver Cancer (BCLC) stage was also an important prognostic factor; the median survival times for BCLC stages A, B and C were 251, 175 and 40 d, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Anti-tumor therapy during the follow-up period, without a history of anti-tumor therapy prior to HCC rupture, small tumor length and number, and early BCLC stage are the most crucial predictors associated with satisfactory overall survival. Other factors play only a small role in overall survival.
authors.affiliation: Xiang-Jun Han, Hong-Ying Su, Hai-Bo Shao, Ke Xu, Department of Radiology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
authors.forename: Xiang-Jun
authors.initials: XJ
authors.lastname: Han
authors.affiliation: Xiang-Jun Han, Hong-Ying Su, Hai-Bo Shao, Ke Xu, Department of Radiology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
authors.forename: Hong-Ying
authors.initials: HY
authors.lastname: Su
authors.affiliation: Xiang-Jun Han, Hong-Ying Su, Hai-Bo Shao, Ke Xu, Department of Radiology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Shao
authors.affiliation: Xiang-Jun Han, Hong-Ying Su, Hai-Bo Shao, Ke Xu, Department of Radiology, the First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Xu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001639:Bicarbonates / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D001639:Bicarbonates; D014408:Biomarkers, Tumor; D012709:Serum Albumin; D000410:Alanine Transaminase; D000075462:Serum Albumin, Human
keywords: Hepatocellular carcinoma; Prognosis; Rupture; Surgery; Transarterial embolization