Efficacy and prognostic factors of transarterial embolization as initial treatment for spontaneously ruptured hepatocellular carcinoma: a single-center retrospective analysis in 57 patients
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To evaluate the efficacy and prognostic factors following transarterial embolization (TAE) as initial treatment for spontaneously ruptured hepatocellular carcinoma (HCC).
From June 2012 to June 2016, a total of 57 spontaneously ruptured HCC patients who received TAE as initial therapy were retrospectively studied at our institution. Patients were followed until October 2016. Survival rates were estimated using the Kaplan–Meier method, and prognostic factors related to survival were evaluated using Cox regression analysis.
Among them, 8 (14.0%) patients died within 30 days after initial TAE. The median overall survival time was 208 days. The 6-month, 1-year, and 2-year cumulative overall survival rates were 50.3%, 35.9%, and 14.7%, respectively. Multivariate analysis indicated that tumor size [HR (hazard ratio) 1.12; 95% CI (confidence interval) 1.02–1.23, P = 0.022] Child–Pugh class (HR 1.78; 95% CI 1.13–2.80; P = 0.013), absence of shock on admission (HR 0.40; 95% CI 0.17–0.95; P = 0.039), and embolization with lipiodol and gelatin sponge particles (HR 0.33; 95% CI 0.16–0.70; P = 0.004) were independent prognostic factors for survival.
TAE appeared to be an effective initial treatment for spontaneously ruptured HCC. The results indicated that large tumors, poor Child–Pugh class, and shock on admission were associated with poor prognosis. For these patients, embolization with lipiodol and gelatin sponge particles could achieve better survival than PVA particles used.
KeywordsHepatocellular carcinoma Prognostic factors Spontaneous rupture Transarterial embolization
We would like to thank Jin LIU from the First Affiliated Hospital of Nanjing Medical University for his Statistical Work.
Compliance with ethical standards
Conflict of interest
No conflict of interest to declare.
- 3.Aoki T, Kokudo N, Matsuyama Y, Izumi N, Ichida T, Kudo M, Ku Y, Sakamoto M, Nakashima O, Matsui O, Makuuchi M, Liver Cancer Study Group of J. Prognostic impact of spontaneous tumor rupture in patients with hepatocellular carcinoma: an analysis of 1160 cases from a nationwide survey. Ann Surg. 2014;259:532–4.CrossRefGoogle Scholar
- 8.Kirikoshi H, Saito S, Yoneda M, Fujita K, Mawatari H, Uchiyama T, Higurashi T, Imajo K, Sakaguchi T, Atsukawa K, Sawabe A, Kanesaki A, Takahashi H, Abe Y, Inamori M, Kobayashi N, Kubota K, Ueno N, Nakajima A. Outcomes and factors influencing survival in cirrhotic cases with spontaneous rupture of hepatocellular carcinoma: a multicenter study. BMC Gastroenterol. 2009;9:29–3.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Schwarz L, Bubenheim M, Zemour J, Herrero A, Muscari F, Ayav A, Riboud R, Ducerf C, Regimbeau JM, Tranchart H, Lermite E, Petrovai G, Suhol A, Doussot A, Capussotti L, Tuech JJ, Le Treut YP, Association F. Bleeding recurrence and mortality following interventional management of spontaneous HCC rupture: results of a Multicenter European Study. World J Surg. 2018;42:225–32.CrossRefPubMedGoogle Scholar
- 13.Kudo M, Kitano M, Sakurai T, Nishida N. General rules for the clinical and pathological study of primary liver cancer, nationwide follow-up survey and clinical practice guidelines: the outstanding achievements of the Liver Cancer Study Group of Japan. Dig Dis. 2015;33:765–70.CrossRefPubMedGoogle Scholar