Is Emergency Transcatheter Hepatic Arterial Embolization Suitable for Spontaneously Ruptured Hepatocellular Carcinoma in Child-Pugh C Cirrhosis?

Purpose: To evaluate the utility of emergent transcatheter arterial embolization for spontaneously ruptured hepatocellular carcinoma (HCC) in patients with Child-Pugh class C (CPC) liver cirrhosis presenting hemorrhagic shock. Materials and Methods: A study of all 94 patients was retrospectively conducted from January 2006 to January 2016. Sixty patients underwent conservative treatment (control group) and 34 underwent embolization. Results: Embolization provided better stabilization of hemodynamic status than conservative treatment (91.2% vs 61.7%), with greater overall survival (OS) rates at 30, 60, and 120 days (73.5%, 52.9%, and 29.4% vs 33.3%, 13.3%, and 0%, respectively). Mean follow-up duration was 51.07 days (range, 3-237 d). Median survival time was longer for the embolization group than the control group, specifically for patients with a shock index (SI) of >= 0.6 to < 1 (106.0 d +/- 39.4 vs 34.0 d +/- 4.7) or >= 1 (18.0 d +/- 7.5 vs 11.0 d +/- 3.2), those with CPC scores 10 or 11 (88.0 d +/- 29.4 vs 28.0 d +/- 4.5), and those with segmental (165.0 d +/- 20.6 vs 34.0 d +/- 9.7) or lobar (54.0 d +/- 7.9 vs 26.0 d +/- 3.4) portal vein tumor thrombus (PVTT). SI >= 1, Child-Pugh score of 12/13, tumor size >= 10 cm, and PVTT were independent factors in poor prognosis for OS. Conclusions: Emergent transcatheter arterial embolization is an effective intervention for ruptured HCC in patients with CPC liver function in hemorrhagic shock, particularly those with a SI >= 1, Child-Pugh scores of 10/11, and first- or lower-order PVTT.