Abstract
Background/Aims
Spontaneous rupture of hepatocellular carcinoma (HCC) is a rare but life-threatening
complication. Although the prevalence rate and mortality of HCC has been reportedly high in Korea, studies
on ruptured HCC are limited. The aim of this study was to determine the clinical characteristics and prognostic
factors of ruptured HCC. Methods: Among 886 cases with HCC that had been diagnosed at Chonnam National
University Hospital from January 2002 to December 2007, 62 cases (7.0%) with ruptured HCC were studied
retrospectively regarding their clinical characteristics and prognostic factors. Results: Transarterial embolization
was performed in 56 cases (90.3%) to control bleeding, with a hemostasis success rate of 89.3%. The
survival time after the rupture of HCC was 8.0±1.7 months (mean±SD), although it was longer in HCC cases
that were first diagnosed in a ruptured state or ruptured with a small amount of bleeding than in those that
ruptured during follow-up after diagnosis or with a large amount of bleeding, respectively. The 30-day
mortality rate in patients with a ruptured HCC was 43.5%, and the early deaths were independently associated
with the presence of hepatic encephalopathy (odds ratio, OR=44.7; 95% confidence interval, CI=1.9-1051.1;
P=0.018), serum bilirubin >3.0 mg/dL (OR=36.7; 95% CI=1.3-1068.5; P=0.036), and the massive or diffuse type
of tumor morphology (OR=53.5; 95% CI=3.0-964.2; P=0.007). Conclusions: The prognosis in patients with
ruptured HCCs was poor with a 30-day mortality of 43.5%. The early deaths after the rupture of HCC were
associated with elevated serum bilirubin levels, hepatic encephalopathy, and the massive or diffuse type of
tumor morphology. (Korean J Hepatol 2009;15:148-158)
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