Spontaneously Ruptured Hepatocellular Carcinoma Treated by Transarterial Embolization Compared with Conservative Treatment: Survival Outcome and Prognostic Factors

Abstract

Objective: To report the survival outcome and prognostic factors in the patients with spontaneously ruptured hepatocellular carcinoma treated by transarterial embolization compared with conservative treatment.
Materials and Methods: A retrospective review of 89 patients who had spontaneous rupture of hepatocellular carcinoma (HCC) at Siriraj Hospital between January 2011 and February 2017 were enrolled. Ruptured HCC patients are diagnosed by clinical presentations of abdominal pain/distension, anemia/shock with dynamic liver computed tomography findings as: hemoperitoneum, focal discontinuity or tumor protrusion of the hepatic surface and/or active contrast material extravasation. We compared the survival outcome and prognostic factors of the ruptured HCC patients who received two treatment methods; conservative treatment and transarterial embolization (TAE).
Results: The cumulative median survival time of the ruptured HCC patients was significantly higher in the TAE group (81 days) than in the conservative treatment group (29 days) with p-value = 0.006. There were two significant predictors for post-treatment mortality. First, treatment modality in the TAE group showed a significantly lower mortality rate than in the conservative treatment group with a hazard ratio (HR) 0.454 (p-value = 0.003). Second, a pre-treatment high hematocrit level was a significant predictive factor for lower mortality than a low hematocrit level with a hazard ratio (HR) 0.946 (p-value = 0.016).
Conclusion: TAE results in a good clinical outcome and increased survival rate in the patients with ruptured HCC. A pre-treatment high hematocrit level was a good prognostic factor for the survival in ruptured HCC patients.