Ajanakitti W, Bannangkoon K, Tubtawee T, Ina N. Tumor protrusion assessment and clinical integration for enhanced mortality risk prediction in spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol 2026; 32(42): 120476 [DOI: 10.3748/wjg.120476]
Corresponding Author of This Article
Kittipitch Bannangkoon, MD, Associate Professor, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanchanawanit Road, Hat Yai 90110, Songkhla, Thailand. drkittipitch@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 14, 2026; 32(42): 120476 Published online Nov 14, 2026. doi: 10.3748/wjg.120476
Tumor protrusion assessment and clinical integration for enhanced mortality risk prediction in spontaneously ruptured hepatocellular carcinoma
Wasittee Ajanakitti, Kittipitch Bannangkoon, Teeravut Tubtawee, Natee Ina
Wasittee Ajanakitti, Kittipitch Bannangkoon, Teeravut Tubtawee, Natee Ina, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
Author contributions: Ajanakitti W, Bannangkoon K, Tubtawee T, and Ina N contributed to conceptualization, study methodology, data collection and analysis, and data curation; Ajanakitti W and Bannangkoon K were responsible for visualization, manuscript writing, and editing; Bannangkoon K supervised the study and critically reviewed the manuscript.
Institutional review board statement: This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Faculty of Medicine, Prince of Songkla University and Songklanagarind Hospital (REC.68-413-7-3).
Informed consent statement: The requirement for informed consent was waived due to the retrospective design of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Kittipitch Bannangkoon, MD, Associate Professor, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanchanawanit Road, Hat Yai 90110, Songkhla, Thailand. drkittipitch@gmail.com
Received: February 28, 2026 Revised: March 10, 2026 Accepted: April 10, 2026 Published online: November 14, 2026 Processing time: 206 Days and 14.3 Hours
Core Tip
Core Tip: Spontaneously ruptured hepatocellular carcinoma carries a high 30-day mortality risk. Current assessment of tumor protrusion remains largely subjective, and existing prognostic models often lack precision in acute settings. This study identifies “protrusion area” (PA) as a superior predictor of early mortality compared to other metrics. We developed the PA-bilirubin-albumin score, which significantly outperforms conventional scoring systems (area under the receiver operating characteristic curve = 0.813). By stratifying patients into three distinct risk groups, the PA-bilirubin-albumin score provides clinicians with a robust, objective tool for rapid bedside decision-making, helping to identify patients who may benefit more from palliative care than from futile aggressive interventions.
