LONG-TERM OUTCOMES OF RUPTURED HEPATOCELLULAR CARCINOMA

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Hepatology

Abstract

Background: It is estimated that spontaneous rupture of hepatocellular carcinoma (HCC) occurs in 2-5% of patients with HCC. Long-term outcomes in patients with ruptured HCC are not well described. Ruptured HCC requires a stepwise approach with control of bleeding followed by treatment for HCC. The spectrum of treatment options has expanded over the years for HCC. This study describes a single-center tertiary referral center experience with treating patients longitudinally with ruptured HCC. Methods: Between 2014 to 2022, our center experienced 7 cases of initial HCC presentation with a spontaneously ruptured hepatocellular carcinoma. Results: The average age of patients with ruptured HCC was 60 years old. Six of the patients (85.7%) were male and one patient (14.1%) was female. Six of the seven patients had underlying cirrhosis with 50% due to HCV, 33% due to alcohol and 16% due to a combination of HCV and alcohol. Three (42.9%) of the patients had Barcelona Clinic Liver Cancer (BCLC) stage B disease at presentation and four (57.1%) of the patients had BCLC stage C disease. None of the patients who presented with ruptured HCC were in an HCC screening protocol. Five (71.4%) of the patients had solitary hepatomas while two (28.6%) of the patients had multiple hepatomas at diagnosis. Both patients with multiple hepatomas had bilobar involvement. The median AFP level at presentation was 23.6 ng/mL (range 5.2 ng/mL to>30000 ng/mL). Two (28.6%) of the patients at presentation were on aspirin and one (14.1%) was on a direct-acting oral anticoagulant (DOAC). Five of our patients were initially treated with bland embolization and two were initially treated with TACE. The patients received various subsequent treatments including bland embolization, TACE, TARE, SBRT and systemic therapies. None of our patients received surgical management or liver transplantation. The median overall survival from date of rupture was 817 days (range 381 d to 2796 d). Conclusion: Our series highlights the wide spectrum of outcomes for patients with ruptured HCC. With improved treatment options, patient survival has increased. In this study, all patients survived at least one year and the longest survival was over 7 years. Noting the improved consideration by UNOS to patients with distant HCC rupture being considered for liver transplantation, continued attention to this group of patients can improve their outcomes.

Volume

78

First Page

S1860

Last Page

S1861

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