BACKGROUNDS/AIMS: The incidence of the spontaneous rupture of hepatocellular carcinoma (HCC), which is a life-threatening condition, is reported to be 2.2-17.9% in Korea. This study was conducted to analyze the risk factors of HCC rupture and to make a treatment strategy. METHODS: We reviewed 370 patients with HCC in terms of the clinicopathologic features, the prognosis according to the type of treatment. RESULTS: The incidence of HCC rupture was 13% (48/370). The suspected risk factors of tumor rupture, except protrusion of tumor, showed no significant difference in this series. Among the 48 patients with ruptured HCC, 15 underwent hepatic resection and the remaining 33 received hepatic artery ligation, transarterial embolization or conservative management. The median survival time of patients with resection and non-resection were 9.0+/-2.4 months and 0.6+/-0.2 months respectively (p<0.05). In stage VI A HCC, the median survival time of patients with resection and non-resection were 6.0+/-1.5 months and 0.6+/-0.2 months, respectively (p<0.05). CONCLUSIONS: The protrusion of tumor beyond the liver surface is the only significant risk factor of HCC rupture. Partia hepatectomy seems to be an effective modality for lifesaving as well as long-term survival for patients with ruptured HCC.