Clinical Research Papers:
Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma
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Yeonjung Ha1,2, Danbi Lee1, Ju Hyun Shim1, Young-Suk Lim1, Han Chu Lee1, Young-Hwa Chung1, Yung Sang Lee1, Sook Ryun Park3, Min-Hee Ryu3, Baek-Yeol Ryoo3, Yoon-Koo Kang3 and Kang Mo Kim1
1 Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
2 Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Republic of Korea
3 Department of Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
Kang Mo Kim, email:
Keywords: hepatocellular carcinoma; portal vein invasion; sorafenib; overall survival; transarterial chemoembolization
Received: May 05, 2016 Accepted: July 19, 2016 Published: August 02, 2016
Background: Although sorafenib is considered standard therapy for advanced hepatocellular carcinoma (HCC), actual treatments vary. We evaluated the effects of different treatment strategies on overall survival.
Methods: A retrospective study of sorafenib-treated patients with advanced HCC was conducted. The primary outcome was overall survival. Prognostic factors were analyzed using multivariate Cox-proportional hazards model.
Results: A total of 658 patients (mean age, 54.5 years; 83.3% male) were analyzed; 293, 129, and 236 patients were treated with sorafenib, a combination therapy of sorafenib and transarterial chemoembolization (TACE), and TACE followed by sorafenib, respectively. Overall, 51.2% of patients treated under the combination strategy had portal vein invasion, whereas 89.9% of patients receiving sorafenib monotherapy had distant metastasis. Median overall survival durations were comparable (11.8 months for sorafenib, 16.2 months for the combination therapy, and 13.5 months for TACE followed by sorafenib; P = 0.13). However, among portal vein invasion cases, combination (25.7 months, P = 0.002) and TACE followed by sorafenib (14.0 months, P = 0.030) treatments were associated with longer overall survival duration compared with than sorafenib monotherapy (5.5 months). In a multivariate model, sorafenib duration (hazard ratio [HR], 0.96, P < 0.001) and TACE (HR, 0.24, P < 0.001) along with Child-Pugh stage (HR, 1.83, P = 0.005) were associated with better survival.
Conclusions: In patients with portal vein invasion, TACE performed concurrently with or before sorafenib administration is associated with better survival.
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