title: Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: A retrospective matched-cohort study.
abstract: BACKGROUND
  Hepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors. Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC. However, later reports declined any benefit.
  
  
  OBJECTIVE
  To study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC.
  
  
  METHODS
  This retrospective matched-cohort study was conducted at Tanta Cancer Center (TCC), Egypt where 116 advanced HCC cases treated with tamoxifen were compared to TNM stage and Child-Pugh class matched 116 HCC cases who received BSC.
  
  
  RESULTS
  The median OS in the tamoxifen group was 9.3 months (95% confidence interval [CI], 6.7-11.9 months) compared to 8.7 months (95%CI, 6.8-10.6) in the BSC group (p=0.758). With univariate analyses, it was shown that absence of fatigue, Child-Pugh class A, single tumors, less advanced tumors (T2), and absence of metastases (M0), had significantly better OS than their counterparts. Multivariate analysis showed that absence of fatigue, Child-Pugh class A and T2 tumors were independent prognostic factors affecting OS. Tamoxifen produced partial response and clinical stabilization in one% and 16% of cases, respectively. The median PFS with tamoxifen was 7.2 months (95%CI, 5.2-9.5).
  
  
  CONCLUSIONS
  Tamoxifen did not show any OS advantage in Egyptian patients with advanced HCC. Use of this drug is discouraged.
authors.affiliation: Medical Oncology/Hematology, National Cancer Institute, Cairo University, Egypt. Electronic address: azeeneldin@gmail.com.
authors.forename: Ahmed Abdelmabood
authors.initials: AA
authors.lastname: Zeeneldin
authors.affiliation: Medical Oncology/Hematology, National Cancer Institute, Cairo University, Egypt.
authors.forename: Salem Mohamed
authors.initials: SM
authors.lastname: Eid
authors.affiliation: Medical Oncology/Hematology, National Cancer Institute, Cairo University, Egypt.
authors.forename: Amira Diaa
authors.initials: AD
authors.lastname: Darweesh
authors.affiliation: Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Egypt.
authors.forename: Manar Mohamed
authors.initials: MM
authors.lastname: Moneer
authors.affiliation: Medical Oncology/Hematology, Tanta Cancer Center, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Saadeldin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000473:pathology; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013629:Tamoxifen / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: Egypt; Hepatocelluar carcinoma; Matched cohort; Tamoxifen; Treatment