Publication Name	World Journal of Gastroenterology
Manuscript ID	120476
Country	Thailand

Category	Gastroenterology & Hepatology
Manuscript Type	Retrospective Cohort Study
Article Title	Tumor protrusion assessment and clinical integration for enhanced mortality risk prediction in spontaneously ruptured hepatocellular carcinoma
Manuscript Source	Unsolicited Manuscript
All Author List	Wasittee Ajanakitti, Kittipitch Bannangkoon, Teeravut Tubtawee and Natee Ina
Funding Agency and Grant Number
Corresponding Author	Kittipitch Bannangkoon, Associate Professor, MD, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Kanchanawanit Road, Hat Yai 90110, Songkhla, Thailand. drkittipitch@gmail.com
Key Words	Hepatocellular carcinoma; Tumor rupture; Transarterial chemoembolization; Prognosis; Risk score
Core Tip	Spontaneously ruptured hepatocellular carcinoma carries a high 30-day mortality risk. Current assessment of tumor protrusion remains largely subjective, and existing prognostic models often lack precision in acute settings. This study identifies “protrusion area” (PA) as a superior predictor of early mortality compared to other metrics. We developed the PA-bilirubin-albumin score, which significantly outperforms conventional scoring systems (area under the receiver operating characteristic curve = 0.813). By stratifying patients into three distinct risk groups, the PA-bilirubin-albumin score provides clinicians with a robust, objective tool for rapid bedside decision-making, helping to identify patients who may benefit more from palliative care than from futile aggressive interventions.
Citation	Ajanakitti W, Bannangkoon K, Tubtawee T, Ina N. Tumor protrusion assessment and clinical integration for enhanced mortality risk prediction in spontaneously ruptured hepatocellular carcinoma. World J Gastroenterol 2026; In press

Received	2026-02-28 01:03
Peer-Review Started	2026-02-28 01:03
First Decision by Editorial Office Director	2026-03-03 09:42
Return for Revision	2026-03-03 09:42
Revised	2026-03-10 07:04
Publication Fee Transferred	2026-03-11 03:28
Second Decision by Editor	2026-04-10 02:46
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-04-10 07:47
Articles in Press	2026-04-10 07:47
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1007-9327 (print) and 2219-2840 (online)
Open Access	This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
Copyright	©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
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