A multicenter analysis of prognostic factors in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib.

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e14532 Background: Established clinical prognostic systems for advanced HCC were previously developed in the era of conventional chemotherapy. In 2008, the molecularly targeted agent sorafenib became the new standard of care. It is unclear if these existing models provide useful prognostic information for patients receiving sorafenib. Our aims were to: 1) evaluate the current utility of 4 known prognostic systems, including the Okuda, CLIP, BCLC, and French classification systems; and 2) identify new prognostic factors for patients treated with sorafenib. Methods: All patients diagnosed with advanced HCC from 2008 to 2010 and treated with sorafenib at any 1 of 6 regional cancer cancers in either British Columbia or Ontario, Canada were reviewed. Patients were risk-stratified using each of the 4 established prognostic systems to determine if these correlated with overall survival (OS). Cox proportional hazards models were also constructed to examine for associations between other clinical factors and OS. Results: Of 205 patients identified, 193 were evaluable: median age was 66 years, 79% were men, and 49% / 19 % / 16% had hepatitis B, C, and alcohol-related liver disease, respectively. The mean number of sorafenib cycles was 5.5 and median OS was 7.1 months. Of the 4 known prognostics models, only the French system proved useful where the high, intermediate, and low risk groups demonstrated a median OS of 2.4, 7.0, and 16.8 months, respectively (p<0.0001). Among other clinical factors, univariate analyses showed that poor performance status, presence of ascites, and large tumor size >5cm were associated with worse OS as were an elevated serum AFP, AST, GGT, or ALP level and a low albumin or hemoglobin level (all p<0.05). In multivariate analyses, none of these clinical factors continued to be independently predictive of outcome (all p>0.05). Conclusions: Except for the French classification system, clinical prognostic factors that were identified in the era of conventional chemotherapy were not useful in this Western cohort of advanced HCC patients treated with sorafenib. There is a need for molecular biomarkers that may provide better prognostic information.