Development and validation of an imaging and clinical scoring system to predict early mortality in spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization
- 23 Downloads
To develop and validate a scoring system using a combination of imaging and clinical parameters to predict 30-day mortality in ruptured HCC (rHCC) patients after transarterial embolization (TAE).
98 consecutive patients with rHCC who underwent abdominal CT and subsequent TAE between January 2007 and December 2016 were retrospectively reviewed. The CT scans were reviewed by two radiologists blinded to the patient outcome. Clinical parameters including serum bilirubin, albumin, INR, creatinine, and hemoglobin were recorded. Independent risk factors for 30-day mortality after TAE were identified using multivariate binary logistic regression, for development of a scoring system. The scoring system was then validated in 20 patients between January 2017 and May 2018.
In the development cohort, bilobar tumor distribution (OR = 29.6), clinical parameters of bilirubin > 2.5 mg/dL (OR = 5.9), and albumin < 30 g/L (OR = 4.1) were independent predictors for 30-day mortality. A 6-point score was derived and yielded area-under-the-receiver-operating-characteristic-curve (AUC) of 0.904. A score ≥ 4 resulted in sensitivity of 80.5% and specificity of 91.2% for 30-day mortality. In the validation cohort, AUC for 30-day mortality was 0.939. A score ≥ 4 resulted in sensitivity of 81.2% and specificity of 88.9%. In both development and validation cohorts, the proposed scoring system was better than biochemical components of Child–Pugh score and serum bilirubin to predict 30-day mortality.
Imaging and clinical parameters can be combined into a scoring system to accurately predict 30-day mortality after TAE in rHCC patients. The score may help identify and counsel high-risk patients.
KeywordsHepatocellular carcinoma Spontaneous rupture Therapeutic embolization Prognostic factors
- 5.Lai EC, Wu KM, Choi TK, Fan ST, Wong J (1989) Spontaneous ruptured hepatocellular carcinoma. An appraisal of surgical treatment. Ann Surg 210 (1):24-28Google Scholar
- 9.Miyamoto M, Sudo T, Kuyama T (1991) Spontaneous rupture of hepatocellular carcinoma: a review of 172 Japanese cases. Am J Gastroenterol 86 (1):67-71Google Scholar
- 10.Xu HS, Yan JB (1994) Conservative management of spontaneous ruptured hepatocellular carcinoma. Am Surg 60 (8):629-633Google Scholar
- 15.Fan WZ, Zhang YQ, Yao W, Wang Y, Tan GS, Huang YH, Yang JY, Li JP (2018) Is Emergency Transcatheter Hepatic Arterial Embolization Suitable for Spontaneously Ruptured Hepatocellular Carcinoma in Child-Pugh C Cirrhosis? J Vasc Interv Radiol 29 (3):404-412 e403. https://doi.org/10.1016/j.jvir.2017.09.022
- 16.Schwarz L, Bubenheim M, Zemour J, Herrero A, Muscari F, Ayav A, Riboud R, Ducerf C, Regimbeau J, Tranchart H, Lermite E, Petrovai G, Suhol A, Doussot A, Capussotti L, Tuech J, Le Treut Y (2018) Bleeding Recurrence and Mortality Following Interventional Management of Spontaneous HCC Rupture: Results of a Multicenter European Study. World J Surg 42(1):225-232CrossRefGoogle Scholar
- 19.Kung CT, Liu BM, Ng SH, Lee TY, Cheng YF, Chen MC, Ko SF (2008) Transcatheter arterial embolization in the emergency department for hemodynamic instability due to ruptured hepatocellular carcinoma: analysis of 167 cases. AJR Am J Roentgenol 191 (6):W231-239. https://doi.org/10.2214/AJR.07.3983 CrossRefGoogle Scholar
- 23.Zhou C, Zu Q, Wang B, Zhou C, Shi H, Liu S (2018) Efficacy and prognostic factors of transarterial embolization as initial treatment for spontaneously ruptured hepatocellular carcinoma: a single-center retrospective analysis in 57 patients. Jpn J Radiol. https://doi.org/10.1007/s11604-018-0799-z