Overall survival in response to sorafenib withtransarterial chemoembolization for BCLCstage B hepatocellular carcinoma: propensityscore analysis .

Abstract

Barcelona clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) is a heterogeneous disease group. Transarterial chemoembolization (TACE) is indicated for BCLC stage B HCC, while sorafenib is indicated for BCLC stage C HCC. This study aimed to evaluate the efficacy of TACE+sorafenib compared with TACE monotherapy in the treatment of BCLC stage B HCC. Patients with BCLC stage B unresectable HCC. This was a retrospective study in patients with BCLC stage B HCC who received TACE (n=144) or TACE+sorafenib (n=46) between January 2008 and January 2014. Child-Pugh classification, history of hepatitis or cirrhosis, nodule number, tumor vascularity, ECOG performance status, adverse events, and survival were evaluated. Patients were matched 1:1 using the propensity score approach. Median overall survival (OS) was 18.0 months in the TACE+sorafenib group compared with 10.0 months for TACE (p=0.002). In matched patients, multivariate analysis showed that the use of TACE+sorafenib (HR=0.351, 95%CI: 0.215-0.574, p<0.001) and multiple-diffuse nodules (HR=0.497, 95% CI: 0.293-0.884, p=0.010) were independently associated with a better prognosis. Subgroup analysis showed survival benefits for patients with Child-Pugh A classification (p=0.001), cirrhosis (p=0.001), hepatitis B (p<0.001), hypovascular lesion (p=0.001), and both single/multiple nodules p=0.001). Cumulative rates of adverse events were similar between the two groups (p=0.155), but hand-foot syndrome (58.7% vs. 12.5%, p<0.001) and diarrhea (60.9% vs. 40.3%, p=0.02) were more frequent in the TACE+sorafenib group. The combination of TACE+sorafenib might improve the OS of patients with BCLC stage B HCC. These results also suggest that some subsets of patients could benefit more from the TACE+sorafenib combination. .