Abstract
Sorafenib, an oral multikinase inhibitor, is approved for advanced hepatocellular carcinoma (HCC) treatment. However, its therapeutic effect in advanced HCC patients with extrahepatic metastasis remains uncertain. This study aimed to prospectively assess the efficacy, safety, and survival risk factors and evaluate the prognostic impact of sorafenib treatment in advanced HCC patients with or without extrahepatic metastasis. Between May 2009 and March 2014, 312 consecutive advanced HCC patients who received sorafenib were enrolled in this study. We evaluated their characteristics and compared the clinical outcomes of those with and without extrahepatic metastasis. Of the enrolled patients, 245 (81%) received sorafenib treatment for more than 1 month, with a median duration of 3.6 months. Eighteen patients demonstrated partial response to sorafenib therapy, 127 had stable disease, and 134 had progressive disease at the first radiologic assessment. The median survival time (MST) and progression‐free survival (PFS) were 10.3 and 3.6 months, respectively. Multivariate analysis identified gender, Child‐Pugh class, baseline serum des‐gamma‐carboxy prothrombin level, and treatment duration as independent risk factors for survival. Extrahepatic metastasis was detected in 178 patients. However, the MST, PFS, and therapeutic effect were comparable between patients with and without extrahepatic metastasis. The independent risk factors for decreased overall survival in patients with extrahepatic metastasis were similar to those affecting all patients. Our results indicated that sorafenib could be administered for hepatic reserve and as long‐term treatment for advanced HCC patients regardless of their extrahepatic metastasis status.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world [1]
Chronic hepatitis C virus infection was the predominant cause of HCC (n = 189; 62%), followed by chronic hepatitis B virus infection (n = 55; 23%)
HR, hazard ratio; 95% CI, 95% confidence interval; BCLC, Barcelona Clinic Liver Cancer; AFP, alpha-f etoprotein; des- gamma-carboxy prothrombin (DCP), des-g amma-c arboxy prothrombin; PD, progressive disease
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world [1]. Recent advances in imaging have increased the early detection rate of HCC. Curative therapies, such as hepatic resection, liver transplantation, and radiofrequency ablation, are possible in early-stage HCC and improve patient survival rates [2, 3]. Transarterial chemoembolization is an important locoregional treatment for patients with unresectable HCC [4]. Long-term survival remains limited due to high rates of recurrence, even after such curative therapies [5]. The development of advanced HCC with macroscopic vascular invasion or Sorafenib for HCC With Extrahepatic Metastasis extrahepatic metastasis significantly reduces survival rates, as no effective systemic therapies are available to date [6, 7]
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