Survival outcome of patients with spontaneously ruptured hepatocellular carcinoma treated surgically or by transarterial embolization

Table 1 Baseline clinical characteristics of the 54 patients with ruptured hepatocellular carcinoma n (%)

Variable	Total (n = 54)
Age1, yr	54 (30-87)
Gender (male)	47 (87.0)
Etiology
HBV/HCV/alcohol/others	36 (66.7)/6 (11.1)/7 (13.0)/5 (9.3)
CTP classification
A/B/C	6 (11.1)/23 (42.6)/25 (46.3)
Tumor size1, cm	8.5 (2.9-25.5)
Tumor number
Single/multiple	11 (20.4)/43 (79.6)
Tumor type
Nodular/infiltrative	47 (87.0)/7 (13.0)
Within Milan criteria	4 (7.4)
BCLC stage
0/A/B/C/D	0 (0.0)/3 (5.6)/8 (14.8)/15 (27.8)/28 (51.9)
Vasopressor requirement	13 (24.0)
Alpha-fetoprotein1, ng/mL	1158 (3.0 × 104-6.1 × 104)

¹Median (range). HBV: Hepatitis B virus; HCV: Hepatitis C virus; CTP: Child-Turcotte-Pugh classification; BCLC: Barcelona Clinical Liver Cancer.

Table 2 Clinical parameters of patients according to treatment modality n (%)

Variables	Resection	TAE	Supportive	P value
	6 (11.1)	25 (46.3)	23 (42.6)
Age, yr	59 (42-79)	54 (30-83)	53 (36-87)	NS
Gender (male)	5 (83.3)	22 (88.0)	20 (86.9)	0.95
Hb1, g/dL	8.2 (5.1-12.1)	7.6 (4.5-11.2)	8.1 (2.9-13.6)	NS
Platelet1, × 103/mm3	127.5 (80-236)	139 (11-534)	191 (86-606)	0.034, NS
Prothrombin time1, INR	1.4 (0.7-3.0)	1.3 (1.0-2.3)	2.2 (1.0-6.6)	NS
Albumin1, mg/dL	2.6 (0.4-3.5)	2.9 (1.8-3.7)	2.6 (1.2-4.3)	NS
Total bilirubin, mg/dL	2.3 (0.5-6.2)	1.2 (0.4-5.4)	6.7 (0.6-23.0)	< 0.014 , NS
Creatinine1, mg/dL	1.2 (0.8-2.0)	1.1 (0.6-1.2)	1.9 (0.9-4.9)	< 0.014, 0.015
Tumor type
Nodular/infiltrative	5/1 (83.3/16.7)	21/4 (84/16)	21/2 (91.3/8.7)	0.72
BCLC stage A/B/C/D	3/2/12/0 (50.0/33.3/16.7/0)	0/4/9/12 (0/16/36/48)	0/2/5/16 (0/8.7/21.7/69.6)	< 0.01
Alpha-fetoprotein1, ng/mL	33.9 (3-3.6 × 104)	1345 (3-6.1 × 104)	1389 (19-6.1 × 104)	NS
Vasopressor requirement	1 (16.7)	7 (28.0)	5 (21.7)	0.79
Incomplete hemostasis	1 (16.7)	5 (20)	NA	1.003
Post-treatment liver failure	0 (0)	6 (24)	NA	0.313
Rebleeding	0/5 (0)	1/20 (5.0)	NA	1.003\

¹Median (range);

²1 patient received palliative resection;

³P value between resection and TAE group;

⁴P value between resection and supportive group;

⁵P value between TAE and supportive group. TAE: Transarterial embolization; BCLC: Barcelona Clinical Liver Cancer; NA: Not available; NS: Not significant.

Table 3 Significant predictive factors of post-treatment mortality in spontaneously ruptured hepatocellular carcinoma patients

Variables	Univariate analysis			Multivariate analysis1
	HR	95%CI	P value	HR	95%CI	P value
Age, yr	0.99	0.96-1.01	0.18	0.98	0.95-1.01	0.14
Gender (male)	0.88	0.37-2.09	0.77	-	-	-
INR	1.77	1.30-2.41	< 0.01	0.92	0.49-1.70	0.79
Total bilirubin, mg/dL	1.13	1.07-1.19	< 0.01	1.09	1.13-1.15	< 0.01
Albumin, mg/dL	0.73	0.42-1.03	0.07	0.81	0.49-1.32	0.39
Creatinine, mg/dL	1.86	1.33-2.61	< 0.01	1.46	1.01-2.13	0.04
AFP, ng/mL	1.00	1.00-1.01	0.21	-	-	-
Tumor number multiple vs single	2.45	1.09-5.54	0.03	1.14	0.46-2.83	0.78
Tumor size, cm	1.01	0.96-1.05	0.88	-	-	-
Vasopressor requirement	1.96	1.87-3.29	0.01	2.37	1.13-4.96	0.02
Treatment type
Supportive care (control)	-	-	-	-	-	-
TACE/TAE	0.44	0.03-0.64	0.01	0.13	0.03-0.66	0.01
Surgery	0.15	0.24-0.80	< 0.01	0.41	0.21-0.79	< 0.01

Subjects, n = 54; event, patient death after treatment (n = 47).

¹Cox proportional hazards model. CTP: Child-Turcotte-Pugh classification; AFP: Alpha-fetoprotein; TACE: Transarterial chemoembolization; TAE: Transarterial embolization; INR: International normalized ratio.