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

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.