Survival Outcome and Prognostic Factors of Spontaneous Rupture of Hepatocellular Carcinoma Treated with Transarterial Embolization: A Single-center Experience

Anucha Ahooja; Somharuethai Sangkham

doi:10.64960/srimedj.v41i2.270668

Authors

Anucha Ahooja Department of Radiology, Faculty of Medicine, Khon Kaen University
Somharuethai Sangkham Department of Radiology, Faculty of Medicine, Khon Kaen University

DOI:

https://doi.org/10.64960/srimedj.v41i2.270668

Keywords:

Spontaneous rupture hepatocellular carcinoma, transarterial embolization, survival outcome, prognostic factors, retrospective study

Abstract

Background and objective: Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening complication requiring urgent intervention. Existing studies have identified prognostic factors for ruptured HCC, but a gap exists in understanding these factors in Northeast Thailand. This research aims to investigate survival outcomes and prognostic factors in patients with spontaneous rupture of HCC treated with transarterial embolization (TAE) in the Northeastern region.

Methods: This was a retrospective study including 163 patients with spontaneous rupture of HCC who were treated with TAE at Srinagarind Hospital from January 2018 to December 2022. The diagnosis of spontaneous rupture of HCC was based on clinical presentation and dynamic liver computed tomography findings. Survival outcomes were evaluated using the Kaplan-Meier method, and Cox regression analysis was used to identify associated prognostic factors.

Results: The median overall survival was 143 days. The 3-month, 6-month, and 12-month cumulative overall survival rates were 60.14%, 40.06%, and 29.37%, respectively. In multivariable analysis, factors significantly associated with improved survival included absence of comorbidity (adjusted HR 0.64; 95% CI 0.44–0.93; p=0.018), higher estimated glomerular filtration rate (eGFR) (adjusted HR 0.98; 95% CI 0.98–0.99; p<0.001), lower Model for End-Stage Liver Disease (MELD) score (adjusted HR 0.96; 95% CI 0.93–0.99; p=0.034), and tumor location at hepatic segment 7 (adjusted HR 0.63; 95% CI 0.40–0.99; p=0.043). Tumor location at segment 6 was associated with poorer survival (adjusted HR 1.60; 95% CI 1.05–2.44; p=0.028). The absence of inotropic or vasopressor drug use was not significantly associated with survival in multivariable analysis.

Conclusion: TAE is an effective initial treatment for patients with spontaneous rupture of HCC. Favorable prognostic factors identified in this study included absence of comorbidity, higher eGFR, lower MELD score, and tumor location in hepatic segment 7, whereas tumor location in segment 6 was associated with poorer survival. Early TAE (≤24 hours) demonstrated a trend toward improved survival.

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