Prediction of futility in ruptured hepatocellular carcinoma.

Abstract

Introduction: Prognosis of ruptured hepatocellular carcinoma(HCC) was often poor despite aggressive treatment.This study aimed to identify factors that predict futility in ruptured HCC. Method: A retrospective analysis of all ruptured HCC patients from 2003-2016 was performed.Significant predictors for hospital mortality was analyzed using Cox regression and predictive performance was assessed using receiver operating characteristics(ROC) curve. The scoring system was subsequently validated in a prospective observational study from 2017-2019. Results: The training set consisted of 315 ruptured HCC patients with overall hospital mortality=137/315(43.5%).Transarterial embolization was the mainstay of treatment(145/315,46%) and 51(16.2%)received surgical treatment. Comparison of baseline characteristics between patients with/without hospital mortality was listed in table 1. In multivariate analysis, MELD>14[HR 7.322(4.128-12.988), bilobar HCC[HR 2.555(1.383-4.719),p=0.003], known history of HCC[HR 3.129(1.771-5.529),p< 0.001] and complicated by variceal bleeding[HR 53.414(5.919-481.999),p< 0.001]were significant predictors for hospital mortality. With such scoring system, the ROC curve of training set was in Figure 1(AUC=0.834,p< 0.001). It was validated prospectively from 2017-2019 with 70 patients.Hospital mortality was similar(27/70,38.6%). The median age was 62(32-89) year old and most had hepatitis B related HCC (52/70,74.3%).Rupture was the first clinical presentation in 20(28.6%)patients. The median MELD was 13.33(6-29) and 15(36.6%) presented with shock. The median size of HCC was 12.3(6-29) and most patients had multifocal disease.The area under curve was 0.823(0.719-0.926),p< 0.001 in validation cohort.(Figure 1) When the score was >5, patients had 100% hospital mortality. Conclusions: The scoring system(>5) accurately predicted hospital mortality after ruptured HCC.It could be used to guide treatment intervention and resuscitation in this population.