Korean J Hepatol.  2009 Jun;15(2):148-158. 10.3350/kjhep.2009.15.2.148.

Analysis of the clinical characteristics and prognostic factors of ruptured hepatocellular carcinoma

• Kim YI
• Ki HS
• Kim MH
• Cho DK
• Cho SB
• Joo YE
• Kim HS
• Choi SK
• Rew JS

• KMID: 1381436
• DOI: http://doi.org/10.3350/kjhep.2009.15.2.148

Abstract

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare but life-threatening complication. Although the prevalence rate and mortality of HCC has been reportedly high in Korea, studies on ruptured HCC are limited. The aim of this study was to determine the clinical characteristics and prognostic factors of ruptured HCC.
METHODS
Among 886 cases with HCC that had been diagnosed at Chonnam National University Hospital from January 2002 to December 2007, 62 cases (7.0%) with ruptured HCC were studied retrospectively regarding their clinical characteristics and prognostic factors.
RESULTS
Transarterial embolization was performed in 56 cases (90.3%) to control bleeding, with a hemostasis success rate of 89.3%. The survival time after the rupture of HCC was 8.0+/-1.7 months (mean+/-SD), although it was longer in HCC cases that were first diagnosed in a ruptured state or ruptured with a small amount of bleeding than in those that ruptured during follow-up after diagnosis or with a large amount of bleeding, respectively. The 30-day mortality rate in patients with a ruptured HCC was 43.5%, and the early deaths were independently associated with the presence of hepatic encephalopathy (odds ratio, OR=44.7; 95% confidence interval, CI=1.9-1051.1; P=0.018), serum bilirubin >3.0 mg/dL (OR=36.7; 95% CI=1.3-1068.5; P=0.036), and the massive or diffuse type of tumor morphology (OR=53.5; 95% CI=3.0-964.2; P=0.007).
CONCLUSIONS
The prognosis in patients with ruptured HCCs was poor with a 30-day mortality of 43.5%. The early deaths after the rupture of HCC were associated with elevated serum bilirubin levels, hepatic encephalopathy, and the massive or diffuse type of tumor morphology.

Keyword

Carcinoma, Hepatocellular; Rupture; Prognosis

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*diagnosis/mortality/therapy
Clinical Chemistry Tests
Data Interpretation, Statistical
Female
Humans
Liver Neoplasms/*diagnosis/mortality/therapy
Male
Middle Aged
Prognosis
Retrospective Studies
Rupture, Spontaneous/diagnosis
Severity of Illness Index
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome