Relationship between ethnicity and overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib (S).

Abstract

248 Background: The SHARP and Asia Pacific (AP) trials showed that S improves OS compared to placebo in advanced HCC. However, OS was worse in the AP trial which included predominantly Asian patients. It is unclear if ethnicity, or perhaps Hepatitis B (HBV) infection, is a poor prognostic factor for these patients. The purpose of this study was to determine whether ethnicity affects OS in patients with advanced HCC being treated with S. Methods: All patients treated with S for HCC in Alberta, Canada from 01/2008 to 07/2016 were included. Patient demographics and clinical/pathological variables were retrospectively collected. Patients were dichotomized by ethnicity as either East Asian or not according to a validated list of surnames. Survival outcomes were assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox-proportional hazard model was constructed with ethnicity and relevant clinical/pathological characteristics to assess their impact on survival. Results: A total of 175 patients were included. Mean age was 64 years. 78% were men, 28% were East Asian, and 79% were Child-Pugh A at initiation of S. The most common etiologies of underlying liver disease were Hepatitis C (HCV) (31%), HBV (29%) and alcohol (21%). 42% had distant metastatic disease. The majority of patients had an ECOG performance status of 0 (26%) or 1 (64%). Median OS was 9.0 months in Asians and 9.5 months in non-Asians (p = 0.68). On multivariate analysis, ethnicity (HR 0.76, 95% CI 0.39 – 1.32, p = 0.33) was not a significant prognostic factor for OS. However, lack of distant metastases (HR 0.57 95% CI 0.40 - 0.82, p < 0.01), initial AFP < 400 (HR 0.54 95%CI 0.38 - 0.78, p < 0.01) and 3+ localized treatments (HR 0.60 95% CI 0.39 - 0.92, p = 0.02) were associated with better OS. Further, HBV was associated with inferior OS when compared to HCV (HR 2.12, 95% CI 1.08 - 4.17, p = 0.03). Conclusions: When treated with S in one Canadian province, ethnicity does not appear to be a prognostic factor for OS. However, HCV infection, lack of distant metastases, initial AFP < 400, and 3+ previous localized treatments were significant prognosticators of OS. We are validating these findings in a larger multi-centre Canadian dataset.