Sorafenib Versus Apatinib Both Combined Transarterial Chemoembolization for Hepatocellular Carcinoma With Portal Vein Tumor Thrombosis: A Comparative Retrospective Study.

Yanyan Cao,Bin Liang,Xiaopeng Guo,Tao Sun,Lei Chen,Xuefeng Kan,Tao Ouyang,Chuansheng Zheng,Mingfu Wang

doi:10.3389/fonc.2021.673378

Abstract

ObjectiveTo compare the efficacy and safety of transarterial chemoembolization (TACE) combining with sorafenib or apatinib for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT).MethodsFrom June 2015 to March 2020, a total of 89 consecutive advanced HCC patients with PVTT who were treated with sorafenib-TACE (S-TACE) or apatinib-TACE (A-TACE) in our center were enrolled. The overall survival (OS), time to progression (TTP), tumor response, and adverse events in the two groups were compared.ResultsThere were 32 and 41 patients included in the S-TACE group and A-TACE group, respectively. The median follow-up was 10.0 months (range, 3.0–36.0 months) in the whole study. The median OS (11.0 vs. 10.0 months, P = 0.419), median TTP (5.0 vs. 6.0 months, P = 0.073), and tumor response (P = 0.529) between the S-TACE group and the A-TACE group were not significantly different. The adverse events related to sorafenib or apatinib were tolerable.ConclusionS-TACE and A-TACE exhibited comparable prognosis for HCC patients with PVTT, which provide another effective and safe method of A-TACE for these patients except for conventional S-TACE.

Highlights

Hepatocellular carcinoma (HCC), one of the most common malignancies, is the fourth leading cause of cancer-related death worldwide [1]
Inclusion criteria: [1] age of 18–75 years; [2] diagnosed with HCC according to the American Association for the study of Liver Disease guidelines or European Association for the study of Liver; [3] portal vein tumor thrombosis (PVTT) confirmed by contrast-enhanced computed tomography (CT) or MRI before the transarterial chemoembolization (TACE) procedure; [4] Eastern Cooperative Oncology Group (ECOG) score ≤2 points; [5] Child-Pugh A or B liver function; [6] platelet count ≥60 × 109/L, neutrophil count >1.5 × 109/L, hemoglobin >9 g/dl, prothrombin time
Since some researches revealed that the prognosis was different for HCC patients with different type and response of PVTT [3, 26], we further compared the response of PVTT according to their type, and the overall survival (OS) according to the response of PVTT

Summary

Introduction

Hepatocellular carcinoma (HCC), one of the most common malignancies, is the fourth leading cause of cancer-related death worldwide [1]. PVTT is one of the significant risk factors for the poor prognosis of HCC, and is an important leading cause of HCC-related death in Barcelona Clinic Liver Cancer (BCLC) stage C patients, with a median overall survival (OS) range of 2.7–4.0 months in non-treated people [4, 5]. Sorafenib is able to improve the prognosis of HCC patients with PVTT [10, 11], it is not routinely recommended for HCC patients in clinical practice in China because of its high medical cost but modest survival benefits

Methods

Results

Conclusion