Survival difference among patients with hepatocelluar carcinoma (HCC) based on stage of disease: The pre- and post-sorafenib era.

Abstract

411 Background: Sorafenib was approved for unresectable and metastatic HCC in 2007. We conducted this retrospective study using U.S. Surveillance, Epidemiology and End results (SEER) database to evaluate the relative survival rates of HCC patients before and after the approval of sorafenib. Methods: We analyzed SEER database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (1973-2013 varying). Relative survival at 12,24,36,48 and 60 months interval was measured for patients diagnosed with HCC between 2001 and 2013. Relative survival rates were compared between pre sorafenib (2001-2007) and post sorafenib (2008-2013) eras. Results: A total of 54,901 patients (23,963 in pre sorafenib era and 30,938 in post-sorafenib era) were reported with HCC in SEER database. Relative survival at 5-years significantly improved for HCC patients diagnosed after 2007 (16.00±0.30% vs 18.90±0.30% for pre and post sorafenib era respectively; P-value < 0.001). Relative survival for HCC patients with the solitary tumor was significantly improved (33.10±0.80% vs 35.40±0.90% survival at 5 years for pre and post sorafenib era respectively; P-value < 0.001). Similarly, survival was found to be significantly improved for patients with multiple tumors without vascular invasion (17.10±0.70% vs 19.40±0.80% survival at 5 years for pre and post sorafenib era respectively; p-value < 0.001). Relative survival continued to be poor with no statistically significant difference at any intervals for patients with tumor with vascular invasion (P-value 0.748) or distant metastasis (P-value 0.055). Survival difference was not significant among different age groups and gender between pre and post sorafenib eras. Conclusions: While relative survival significantly improved in post sorafenib era, it is largely limited to patients with the localized disease with the solitary tumor or multiple tumors without any vascular invasion or metastasis. Survival in patients with advanced stage HCC remains poor and has not shown significant improvement since the approval of sorafenib. The study shows better alternatives are needed for advanced-stage unresectable HCC patients.