![]() Since HCC rupture is a catastrophic event which usually accompanied with shock, hypoperfusion and multi-organ dysfunction, nearly half of the morality cases occur in the first month. Since the advance in TAE technique, whether the use of total bilirubin level >3.0 mg/dL alone still being a contraindication or predictive of adverse outcome nowadays is questionable. However, this cut-off value was derived from two cohorts of less than 50 cases 20 years ago. A deteriorated liver function, such as hyperbilirubinemia (total bilirubin level >3.0 mg/dL or >50 μmol/L), was considered as a relative contraindication for TAE in patients with HCC rupture due to high risk of hepatic failure and mortality. ![]() Trans-arterial embolization (TAE) is an efficient and well-tolerated approach to stop tumor bleeding. The primary therapeutic goal in these patients is to achieve stable hemodynamic status rather than anti-cancer treatment. Despite the decreased incidence of spontaneous HCC rupture due to HCC surveillance program which improve early detection rate, the mortality rate within 30 days of HCC rupture remains high up to 34-71% with median survival duration of 7-21 weeks. Spontaneous HCC rupture with intraperitoneal hemorrhage, incidence ranged from 3-14.5%, is a catastrophic life-threatening complication which ranked the third leading cause of death in HCC patients. Hepatocellular carcinoma (HCC) is the sixth most common primary liver tumor and the fourth leading cause of cancer-related deaths worldwide. By multivariate logistic regression analysis, male MELD score [aOR: 13.61, P3 mg/dL be more predictive of post TAE 30-day mortality. The 30-day cumulative mortality rate is 20.4%. The successful hemostatic rate after embolization was 91.4% and the median overall survival was 224 days. Results: A total of 186 patients were enrolled. Pre-TAE characteristics including age, gender, etiology, liver biochemistry, Child-Pugh classification, Model for End-Stage Liver Disease (MELD) score, the presence of shock, tumor staging and post TAE liver function were compared between patients with and without post-TAE 30-day mortality. Methods: Patients with ruptured HCC and treated by TAE between February 2005 and December 2016 in Chang Gung Memorial Hospital, Linkou branch were recruited. This study was aimed to re-evaluate this relative contraindication. However, deteriorated liver function with total bilirubin more than 3 mg/dL was deemed as a relative contraindication. Background and Aims: Spontaneous hepatocellular carcinoma (HCC) rupture is a catastrophic life-threatening complication that could be rescued by trans-arterial embolization (TAE).
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