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AIM:To report the outcome of patients with ruptured hepatocellular carcinoma(HCC)treated at a single center during a 5-year period.METHODS:We retrospectively analyzed 32 patients who presented with ruptured HCC at Shandong Provincial Hospital Affiliated to Shandong University between2008 and 2013.RESULTS:The mean age of the patients was 53 years(range 39-71 years).Of these patients,22 received surgical management,10 underwent transarterial embolization(TAE)or transarterial chemoembolization(TACE),and 12 received sorafenib after surgery,TAE or TACE.Cumulative survival rates at 4,8 and 12 mo were72.9%,50.0%and 33.3%,respectively,in the surgery only group and were 90.0%,80.6%and 64.1%,respectively,in the surgery plus sorafenib group.Cumulative survival rates at 4,8 and 12 mo were 68.4%,43.6%and 19.4%,respectively,in the surgery only or TAE/TACE only groups,and were 91.7%,75.0%and 60.2%,respectively,in the sorafenib combination groups(P=0.04).No unexpected side effects due to sorafenib were observed.The most common side effect was hand-foot skin reaction.To date,5 patients have died.Median follow-up from the start of sorafenib therapy for the remaining 7 patients is 12.7 mo(range5.8-32.2 mo).CONCLUSION:Sorafenib can be used in patients with ruptured HCC as it has interesting activity and is well tolerated;dose adjustment is generally not required.However,a larger prospective study is necessary to determine the efficacy of sorafenib in this group of patients.