Objective:To determine the prognostic factors of ruptured hepatocellular carcinoma (HCC) and report the management of patients with spontaneous rupture of HCC in a single center during a 5-year period and to evaluateone-stage hepatectomy.Methods:A series of 4,209 patients with HCC were collected at East Hepatobiliary Surgery Hospital from April 2002 toNovember 2006,of whom 200 patients (4.8％) with ruptured HCC were studied retrospectively regarding their clinical characteristics and prognostic factors.The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative method,transarterial embolization (rAE) or surgical hepatectomy.Results of various treatments were evaluated and compared in the randomly selected 202 patients with no history of rupture during the same study period.Results:A total of 200 patients with spontaneous rupture of HCC were studied who underwent surgical treatment (n=105),TAE 33 and conservative treatment (ConT 62).A multivariate analysis using the Cox hazard regression model (including all the patients;n=200) identified surgical hepatectomy as the only independent factor determining a relatively long survival period (P<0.0001).On the other hand,in a further analysis of the patients in whom surgical hepatectomy was successfully performed (n=105),which identified a maximum tumor size exceeding 6 cm as significant determinants of a poor 12-month (P=0.036),and a multivariate analysis did not identify as any inverse independent factor determining relatively long-term survival,only a maximum tumor size exceeding 6 cm exhibited a tendency toward being a determinant factor (P=0.083).Conclusion:Considering the high propensity to spontaneous rupture,as long as preoperatively clinical evaluation meet surgery requirements,elective one-stage hepatectomy for patients with ruptured HCC is the first treatment option.Prolonged survival could be achieved in selected patients with hepatic resection,although the survival results were inferior to those of the patients who did not have the complication of rupture.