Treatment strategies and prognosis for initially unresectable ruptured hepatocellular carcinoma: a single-center experience in 94 patients

PURPOSE: We aimed to identify the treatment options and prognostic factors for patients with initially unresectable ruptured hepatocellular carcinoma (HCC). METHODS: Between June 2012 and December 2016, 94 consecutive patients with initially unresectable ruptured HCC were analyzed retrospectively. Patients were followed until December 2017. Predictors of short-term (≤30 days) and long-term (>30 days) survival were identified by using logistic regression model and Cox proportional hazard model, respectively. RESULTS: Of the 94 patients, initial hemostasis was achieved by transarterial embolization (TAE) in 59 patients, surgical hemostasis in 14 patients, and conservative treatment in 21 patients. Twenty-five (26.6%) patients died within 30 days of tumor rupture. In the multivariate analysis, patients treated with aggressive initial treatment strategies (TAE or surgical hemostasis) (P < 0.001) or those with better Child-Pugh class (P = 0.003) and absence of shock on admission (P = 0.001) had a better chance of short-term survival. For 69 patients who survived more than 30 days after initial treatment, the median survival time was 268 days. In the multivariate analysis, among the 69 who survived, early modified LCSGJ stage (P = 0.003) and staged hepatectomy as definitive treatment (P < 0.001) were significant predictors of increased long-term survival. CONCLUSION: Short-term survival of patients with initially unresectable ruptured HCC could be achieved in the presence of better Child-Pugh class, absence of shock, and with the use of aggressive initial treatment strategies. Among survivors of the emergency phase of tumor rupture, long-term survival was significantly increased with early modified LCSGJ stage and staged hepatectomy therapy.