Early Hemostatic Treatment Could Improve 30-Day Survival After Spontaneous Rupture of Hepatocellular Carcinoma

Abstract

Introduction: Spontaneous rupture of hepatocellular carcinoma (SRHCC) presents a critical clinical challenge, with early haemostasis often difficult to achieve and limited data available on subsequent treatment strategies. This study aims to evaluate whether the initial hemostatic approach influences early prognosis and facilitates further treatment of HCC.

Methods: This retroprospective multicentric cohort included patients with SRHCC since 2008. Cox and Kaplan-Meier models analysed factors associated with overall survival (OS).

Results: 112 patients with SRHCC were included. Hemostatic treatment was administered in 54.4% of cases (83.6% embolization, 9.8% surgery and 6.6% embolization plus surgery). The 30-day mortality rate was 28.6%. Factors associated with 30-day mortality included ALBI score > 2 (HR = 4.23; p = 0.001), shock (HR = 2.37; p = 0.029), acute kidney injury (HR = 4.40; p = 0.003), and BCLC stage C/D (HR = 14.29; p = 0.010). Early hemostatic intervention was associated with improved 30-day survival (HR = 0.42; p = 0.033). Palliative care was initiated in 27% of patients (10% after embolization and 17% upon admission). One-third of patients received subsequent HCC treatment after a median of 84 days [IQR: 39-176] (55.3% surgery and 18.4% systemic therapy). Among these, 63% (n = 24) had undergone early hemostatic treatment. The one-year OS rate was 39.3%, the median follow-up duration was 136 days (95% CI: 20.3-739.5), and the median OS was 6.6 ± 4.1 months (95% CI: 0-14.8). Delayed HCC treatment following rupture significantly improved OS (HR = 0.35; 95% CI: 0.20-0.61; p < 0.001), particularly when surgery was performed (p < 0.0001).

Conclusion: Our results suggest that early hemostatic treatment could be beneficial after spontaneous rupture of HCC in well compensated patients.

Trial registration: NCT06505291.

Keywords: atezolizumab; bevacizumab; chemoembolization; embolization; haemorrhage; haemostasis; ruptured hepatocellular carcinoma; sorafenib; surgery.

FIGURE 1

Flow chart.

FIGURE 2

30‐day survival. (a) 30‐day survival of the 112 patients. (b) 30‐day survival without the 19 patients who were considered for palliative care at the time of the rupture (n = 93). (c) 30‐day survival for patients who received an early hemostatic treatment (surgery or embolization) at the time of the rupture compared with those who did not. Numbers at risk were represented under the x‐axis. (d) 30‐day survival for patients who received an early hemostatic treatment (surgery or embolization) at the time of the rupture while HCC was discovered at the time of the rupture compared with the remaining patients of the entire cohort. Numbers at risk were represented under the x‐axis.

FIGURE 3

Overall survival. (a) Overall survival of the 112 patients. (b) Overall survival once the 19 patients considered for palliative care upon the admission removed (n = 93). (c) Comparison between overall survival for patients who received a treatment later after the haemorrhage or not. (d) Comparison between overall survival for patients who received surgical, medical, or no treatment later after the haemorrhage.