Can Emergent Transcathether Arterial Embolization Help Patients With Ruptured HCC?

Patients with Child-Pugh class C (CPC) liver cirrhosis presenting with hemorrhagic shock as a result of spontaneously ruptured hepatocellular carcinoma (HCC) can benefit from emergent transcatheter arterial embolization.

The field has not yet reached a consensus regarding the optimal treatment of such patients and whether embolization is worthwhile in these circumstances. To investigate further, the researchers retrospectively evaluated 94 patients who received treatment from January 2006 to January 2016. Of these patients, 60 were the control group and underwent conservative treatment, and 34 underwent embolization.

The researchers found that embolization led to better stabilization of hemodynamic status than conservative treatment. Overall survival rates were greater among patients treated with embolization, with rates of 73.5%, 52.9%, and 29.4% vs 33.3%, 13.3%, and 0% for conservative treatment at 30, 60, and 120 days.

Additionally, patients treated with embolization had a better median survival time compared with the control group. This improvement was particularly seen among patients with a shock index (SI) of ≥ 0.6 to < 1 or ≥ 1, as well as those with CPC scores 10 or 11, and those with segmental or lobar portal vein tumor thrombus (PVTT).

Several independent factors suggested poor prognosis for overall survival:  SI ≥ 1, Child-Pugh score of 12/13, tumor size ≥ 10 cm, and PVTT.

“Spontaneous rupture is a serious complication of HCC, and the median survival of patients with CPC liver function is extremely short in the absence of treatment. Early emergent embolization can effectively achieve hemostasis and prolong OS, especially in patients with Child– Pugh scores of 10/11 and first- or lower-order PVTT,” the researchers concluded. However, emergent embolization is not suitable for all patients, they added. “Compared with conservative treatment, embolization showed no significant advantage in patients with Child–Pugh scores of 12/13 or main PVTT.”

Reference

Fan WZ, Zhang YQ, Yao W, et al. Is emergency transcatheter hepatic arterial embolization suitable for spontaneously ruptured hepatocellular carcinoma in Child-Pugh C cirrhosis? J Vasc Interv Radiol. 2017 Dec 14. pii: S1051-0443(17)30906-5. doi: 10.1016/j.jvir.2017.09.022. [Epub ahead of print]