Abdominal Radiology

, Volume 44, Issue 3, pp 903–911 | Cite as

Development and validation of an imaging and clinical scoring system to predict early mortality in spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization

  • Kam-Ho LeeEmail author
  • Man-Lap Donald Tse
  • Martin Law
  • Andrew Kai-Chun Cheng
  • Ho-Yuen Frank Wong
  • Man-Leung Yu
  • Yan-Lin Li
  • Yuen-Chi Ho
  • Ferdinand Chu
  • Wendy Wai-Man Lam



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.


Hepatocellular carcinoma Spontaneous rupture Therapeutic embolization Prognostic factors 


  1. 1.
    Liu CL, Fan ST, Lo CM, Tso WK, Poon RT, Lam CM, Wong J (2001) Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol 19 (17):3725-3732. CrossRefGoogle Scholar
  2. 2.
    Yoshida H, Mamada Y, Taniai N, Uchida E (2016) Spontaneous ruptured hepatocellular carcinoma. Hepatol Res 46 (1):13-21. CrossRefGoogle Scholar
  3. 3.
    Moris D, Chakedis J, Sun SH, Spolverato G, Tsilimigras DI, Ntanasis-Stathopoulos I, Spartalis E, Pawlik TM (2018) Management, outcomes, and prognostic factors of ruptured hepatocellular carcinoma: A systematic review. J Surg Oncol 117(3):341-353CrossRefGoogle Scholar
  4. 4.
    Chen WK, Chang YT, Chung YT, Yang HR (2005) Outcomes of emergency treatment in ruptured hepatocellular carcinoma in the ED. Am J Emerg Med 23 (6):730-736. CrossRefGoogle Scholar
  5. 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
  6. 6.
    Li WH, Cheuk EC, Kowk PC, Cheung MT (2009) Survival after transarterial embolization for spontaneous ruptured hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16 (4):508-512. CrossRefGoogle Scholar
  7. 7.
    Monroe EJ, Kogut MJ, Ingraham CR, Kwan SW, Hippe DS, Padia SA (2015) Outcomes of emergent embolisation of ruptured hepatocellular carcinoma in a western population. Clin Radiol 70 (7):730-735. CrossRefGoogle Scholar
  8. 8.
    Shin BS, Park MH, Jeon GS (2011) Outcome and prognostic factors of spontaneous ruptured hepatocellular carcinoma treated with transarterial embolization. Acta Radiol 52 (3):331-335. CrossRefGoogle Scholar
  9. 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. 10.
    Xu HS, Yan JB (1994) Conservative management of spontaneous ruptured hepatocellular carcinoma. Am Surg 60 (8):629-633Google Scholar
  11. 11.
    Choi BG, Park SH, Byun JY, Jung SE, Choi KH, Han JY (2001) The findings of ruptured hepatocellular carcinoma on helical CT. Br J Radiol 74 (878):142-146. CrossRefGoogle Scholar
  12. 12.
    Kim HC, Yang DM, Jin W, Park SJ (2008) The various manifestations of ruptured hepatocellular carcinoma: CT imaging findings. Abdom Imaging 33 (6):633-642. CrossRefGoogle Scholar
  13. 13.
    Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60 (8):646-649CrossRefGoogle Scholar
  14. 14.
    Han K, Song K, Choi BW (2016) How to Develop, Validate, and Compare Clinical Prediction Models Involving Radiological Parameters: Study Design and Statistical Methods. Korean J Radiol 17 (3):339-350. CrossRefGoogle Scholar
  15. 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.
  16. 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
  17. 17.
    Ngan H, Tso WK, Lai CL, Fan ST (1998) The role of hepatic arterial embolization in the treatment of spontaneous rupture of hepatocellular carcinoma. Clin Radiol 53 (5):338-341CrossRefGoogle Scholar
  18. 18.
    Okazaki M, Higashihara H, Koganemaru F, Nakamura T, Kitsuki H, Hoashi T, Makuuchi M (1991) Intraperitoneal hemorrhage from hepatocellular carcinoma: emergency chemoembolization or embolization. Radiology 180 (3):647-651. CrossRefGoogle Scholar
  19. 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. CrossRefGoogle Scholar
  20. 20.
    Jellinge ME, Henriksen DP, Hallas P, Brabrand M (2014) Hypoalbuminemia is a strong predictor of 30-day all-cause mortality in acutely admitted medical patients: a prospective, observational, cohort study. PLoS One 9 (8):e105983. CrossRefGoogle Scholar
  21. 21.
    Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285 (23):2987-2994CrossRefGoogle Scholar
  22. 22.
    Leung KL, Lau WY, Lai PB, Yiu RY, Meng WC, Leow CK (1999) Spontaneous rupture of hepatocellular carcinoma: conservative management and selective intervention. Arch Surg 134 (10):1103-1107CrossRefGoogle Scholar
  23. 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.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kam-Ho Lee
    • 1
    Email author
  • Man-Lap Donald Tse
    • 1
  • Martin Law
    • 1
  • Andrew Kai-Chun Cheng
    • 1
  • Ho-Yuen Frank Wong
    • 1
  • Man-Leung Yu
    • 1
  • Yan-Lin Li
    • 1
  • Yuen-Chi Ho
    • 1
  • Ferdinand Chu
    • 1
  • Wendy Wai-Man Lam
    • 1
  1. 1.Department of RadiologyQueen Mary HospitalHong Kong, HKSARChina

Personalised recommendations