Authors (including presenting author) :
PYC Chien (1), KH Lee (1), JML Yu (1),HYF Wong (1), J Li (1), YC Ho (1), V Lau (1), F Chu (1), PWT Lam (1)
Affiliation :
(1) Department of Radiology, Queen Mary Hospital
Introduction :
Spontaneous rupture of hepatocellular carcinoma (HCC) has a reported incidence ranging from less than 3% in Western population and up to 26% in Asian population. Patients with rupture HCC (rHCC) usually have poor liver function due to liver cirrhosis and advanced tumor status. Previous studies reported 30-day mortality of rHCC was 17-71%, with median survival period 4 to 32 weeks. Transarterial embolization (TAE) has been used to achieve hemostasis in unstable patient with rHCC.
Objectives :
To determined whether transarterial embolization (TAE) offer survival benefit over conservative treatment (BCT) in high-risk patients with ruptured hepatocellular carcinoma (rHCC) as stratified by a newly proposed imaging and scoring system.
Methodology :
A newly proposed imaging and scoring system comprised of serum bilirubin, albumin and bilobar status was used to predict 30-day mortality after TAE for rHCC. Patients were stratified into three groups (high, intermediate and low risks) using the proposed scoring system. Outcome of patients who underwent TAE were compared with controls receiving BCT. The primary outcome is overall survival (OS), as estimated by Kaplan-Meier analysis. The difference of OS between the two groups was evaluated with log-rank test.
Result & Outcome :
Among the 71 high- risk patients, 49 of them were treated with TAE (mean age of 61; range 36-86), while 22 patients received BCT (mean age of 59; range 38-80). Technical success rate of TAE was 100%. All patients had bilobar disease with mean ruptured tumor size larger than 10cm (p=0.580) in both groups. Successful embolization was performed in all patients treated with TAE. There was no significant difference in demographics, hemodynamics, hepatitis B status and biochemical markers between the two groups of patients, except that bilirubin (p=0.035) and AFP level (p=0.003) were higher in BCT group. High-risk patients who were treated with TAE did not show better prognosis (median survival time = 11 days) when comparing to those who received BCT (median survival time = 24 days), and there was no significant difference in OS (p=0.36).
