Brief Article
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World J Gastroenterol. Jul 28, 2013; 19(28): 4537-4544
Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4537
Survival outcome of patients with spontaneously ruptured hepatocellular carcinoma treated surgically or by transarterial embolization
Young-Joo Jin, Jin-Woo Lee, Seoung-Wook Park, Jung Il Lee, Don Haeng Lee, Young Soo Kim, Soon Gu Cho, Yong Sun Jeon, Kun Young Lee, Seung-Ik Ahn
Young-Joo Jin, Jin-Woo Lee, Seoung-Wook Park, Don Haeng Lee, Young Soo Kim, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, South Korea
Jung Il Lee, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
Don Haeng Lee, Department of Internal Medicine and Center for Advanced Medical Education by Brain Korea 21 Project, Inha University School of Medicine, and Utah-Inha DDS and Advanced Therapeutics Research Center, Incheon 400-711, South Korea
Soon Gu Cho, Yong Sun Jeon, Department of Radiology, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, South Korea
Kun Young Lee, Seung-Ik Ahn, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon 400-711, South Korea
Author contributions: Jin YJ and Lee JW contributed to conception and design, collection and assembly of data, analysis and interpretation of the data, drafting of the article, provision of study materials or patients, administrative and technical or logistic support; Park SW, Lee JI, Cho SG, Jeon YS, Lee KY and Ahn SI contributed to collection and assembly of data and provision of study materials or patients; Lee DH and Kim YS contributed to provision of study materials or patients, critical revision of the article for important intellectual content.
Supported by Inha University Research Grant
Correspondence to: Jin-Woo Lee, MD, PhD, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-Gu, Incheon 400-711, South Korea. jin@inha.ac.kr
Telephone: +82-32-8902548 Fax: +82-32-8902549
Received: December 14, 2012
Revised: May 19, 2013
Accepted: June 8, 2013
Published online: July 28, 2013
Processing time: 226 Days and 20.3 Hours
Abstract

AIM: 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 mm3/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.

CONCLUSION: 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.

Keywords: Ruptured hepatocellular carcinoma; Surgery; Transarterial embolization

Core tip: We have shown here that overall survival rates of patients with ruptured hepatocellular carcinoma (HCC) is significantly higher in patients with surgery or transarterial embolization (TAE) than in those with supportive care, and tended to be higher in patients with surgery than in those with TAE. To date, there has been a dearth of reliable clinical evidence on the merits of surgical treatment versus those of TAE, in the context of survival benefit in patients with a spontaneous HCC rupture. Therefore, the present study may provide useful information for clinicians to determine the most appropriate treatment option for spontaneously ruptured HCC.