Chemoembolization Plus Radiotherapy Versus Chemoembolization Plus Sorafenib for the Treatment of Hepatocellular Carcinoma Invading the Portal Vein: A Propensity Score Matching Analysis.

Hee Ho Chu,Jin Hyoung Kim,Sang Min Yoon,Ibrahim Alrashidi,Pyeong Hwa Kim,Ju Hyun Shim

doi:10.3390/cancers12051116

Hee Ho Chu, Jin Hyoung Kim + Show 4 more

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https://doi.org/10.3390/cancers12051116

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Journal: Cancers	Publication Date: Apr 29, 2020
Citations: 25	License type: CC BY 4.0

Affiliation: University of Ulsan, Asan Medical Center, Ulsan College

Abstract

A combination of transarterial chemoembolization (TACE) plus sorafenib or radiotherapy (RT) has demonstrated efficacy in patients with advanced hepatocellular carcinoma (HCC). Here, the two combined treatment approaches were compared in patients with HCC and portal vein tumor thrombus (PVTT). Data from 307 patients treated with TACE plus RT (n = 203) or TACE plus sorafenib (n = 104) as first-line treatment for HCC with PVTT were retrospectively evaluated. Using the propensity model to correct selection bias, 87 patients were included from each treatment group. During follow up (median, 12 months) in the entire study population, the median progression-free survival (PFS) and overall survival (OS) were significantly longer in the TACE plus RT group than in the TACE plus sorafenib group (6.5 vs. 4.3 months, respectively; p = 0.017 and 16.4 vs. 12 months, respectively; p = 0.007). Following propensity score matching, the median PFS and OS in the two groups showed no statistically significant difference. Multivariable analysis found no significant association between PFS or OS and the treatment type. In conclusion, this retrospective study of data from patients with advanced HCC with PVTT shows that PFS and OS did not differ significantly in patients treated with TACE plus RT and TACE plus sorafenib.

Highlights

Advanced hepatocellular carcinoma (HCC; Barcelona Clinic Liver Cancer (BCLC) stage C) describes patients who have symptoms and/or vascular invasion or extrahepatic spread
Patients with chronic hepatitis B virus infection were more prevalent in the transarterial chemoembolization (TACE) plus RT group than in the TACE plus sorafenib group (92.6% vs. 78.8%, respectively), chronic hepatitis C virus carriers were more common in the TACE plus sorafenib group than in the TACE plus RT group
Total bilirubin and AFP levels did not differ between the two groups, the maximal tumor size was larger in the TACE plus sorafenib group

Summary

Introduction

Advanced hepatocellular carcinoma (HCC; Barcelona Clinic Liver Cancer (BCLC) stage C) describes patients who have symptoms and/or vascular invasion or extrahepatic spread. Systemic therapy, such as sorafenib, has emerged as a promising treatment approach for these patients, the survival benefit is limited to < 3 months [1,2]. Previous studies have demonstrated that repeated conventional transarterial chemoembolization (TACE) is associated with significant survival benefits in patients. To date, the reported OS period for HCC patients with portal vein tumor thrombosis (PVTT) who receive TACE is slightly better than that of patients who receive sorafenib therapy

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