Spontaneous Rupture of Hepatocellular Carcinoma: Pathogenesis, Clinical Management, Prognostic Factors, and Future Directions

Yuan Cheng,1,* Feng Ye,2,* Yongjun Chen2 1Department of Medical Oncology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002, People’s Republic of China; 2Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yongjun Chen, Email [email protected]: Spontaneous rupture of hepatocellular carcinoma (srHCC) is a life-threatening complication with complex pathophysiology and heterogeneous clinical presentations. This review aims to provide an up-to-date summary of the pathogenesis, clinical features, treatment strategies, prognostic factors, and emerging research in srHCC. We discuss current understanding of risk factors and rupture mechanisms, outline diagnostic and therapeutic approaches—including surgical, interventional, and systemic options—and explore postoperative management and prognosis. We also highlight recent clinical evidence and unmet research needs. Understanding the multifaceted nature of srHCC is essential to improve outcomes and guide future research directions.Keywords: spontaneous rupture, hepatocellular carcinoma, TACE, conversion therapy, prognosis, adjuvant therapy