{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T20:16:15Z","timestamp":1768162575993,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Spontaneous rupture of hepatocellular carcinoma (SRHCC) presents a critical clinical challenge, with early haemostasis often difficult to achieve and limited data available on subsequent treatment strategies. This study aims to evaluate whether the initial hemostatic approach influences early prognosis and facilitates further treatment of HCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retroprospective multicentric cohort included patients with SRHCC since 2008. Cox and Kaplan\u2013Meier models analysed factors associated with overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      112 patients with SRHCC were included. Hemostatic treatment was administered in 54.4% of cases (83.6% embolization, 9.8% surgery and 6.6% embolization plus surgery). The 30\u2010day mortality rate was 28.6%. Factors associated with 30\u2010day mortality included ALBI score &gt;\u20092 (HR\u2009=\u20094.23;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), shock (HR\u2009=\u20092.37;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029), acute kidney injury (HR\u2009=\u20094.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), and BCLC stage C\/D (HR\u2009=\u200914.29;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). Early hemostatic intervention was associated with improved 30\u2010day survival (HR\u2009=\u20090.42;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033). Palliative care was initiated in 27% of patients (10% after embolization and 17% upon admission). One\u2010third of patients received subsequent HCC treatment after a median of 84\u2009days [IQR: 39\u2013176] (55.3% surgery and 18.4% systemic therapy). Among these, 63% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924) had undergone early hemostatic treatment.\n                    <\/jats:p>\n                    <jats:p>\n                      The one\u2010year OS rate was 39.3%, the median follow\u2010up duration was 136\u2009days (95% CI: 20.3\u2013739.5), and the median OS was 6.6\u2009\u00b1\u20094.1\u2009months (95% CI: 0\u201314.8). Delayed HCC treatment following rupture significantly improved OS (HR\u2009=\u20090.35; 95% CI: 0.20\u20130.61;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), particularly when surgery was performed (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results suggest that early hemostatic treatment could be beneficial after spontaneous rupture of HCC in well compensated patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>NCT06505291<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70332","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T11:13:37Z","timestamp":1758712417000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Early Hemostatic Treatment Could Improve 30\u2010Day Survival After Spontaneous Rupture of Hepatocellular Carcinoma"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5906-5372","authenticated-orcid":false,"given":"Apolline","family":"Commin","sequence":"first","affiliation":[{"name":"Department of Hepatogastroenterology University Hospital  Caen France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chlo\u00e9","family":"Metivier","sequence":"additional","affiliation":[{"name":"Department of Hepatogastroenterology University Hospital  Caen 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Brousse Hospital (APHP)  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc\u2010Antoine","family":"Allard","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery Paul Brousse Hospital (APHP)  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Roux","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Imaging Department La Piti\u00e9 Salp\u00e9tri\u00e8re Hospital (APHP)  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Scatton","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary Surgery La Piti\u00e9 Salp\u00e9tri\u00e8re Hospital (APHP)  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Charles","family":"Nault","sequence":"additional","affiliation":[{"name":"Department of Hepatogastroenterology Avicenne Hospital (APHP)  Paris France"},{"name":"Inserm 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