title: Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: propensity score analysis.
abstract: BACKGROUND
  This study investigated the survival benefits of sorafenib vs. radiotherapy (RT) in patients with unresectable hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) in the main trunk or the first branch.
  
  
  METHODS
  Ninety-seven patients were retrospectively reviewed. Forty patients were enrolled by the Kanagawa Liver Study Group and received sorafenib, and 57 consecutive patients received RT in our hospital. Overall survival was compared between the two groups with PVTT by propensity score (PS) analysis. Factors associated with survival were evaluated by multivariate analysis.
  
  
  RESULTS
  The median treatment period with sorafenib was 45 days, while the median total radiation dose was 50 Gy. The Child-Pugh class and the level of invasion into hepatic large vessels were significantly more advanced in the RT group than in the sorafenib group. Median survival did not differ significantly between the sorafenib group (4.3 months) and the RT group (5.9 months; P = 0.115). After PS matching (n = 28 per group), better survival was noted in the RT group than in the sorafenib group (median survival, 10.9 vs. 4.8 months; P = 0.025). A Cox model showed that des-γ-carboxy prothrombin <1000 mAU/mL at enrollment and RT were significant independent predictors of survival in the PS model (P = 0.024, HR, 0.508; 95% CI, 0.282 to 0.915; and P = 0.007, HR, 0.434; 95% CI, 0.235 to 0.779; respectively).
  
  
  CONCLUSIONS
  RT is a better first-line therapy than sorafenib in patients who have advanced unresectable HCC with PVTT.
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, 2-1-1 Asamizodai, Minami-ku, Sagamihara, Kanagawa 252-0380, Japan. tnakazaw@kitasato-u.ac.jp.
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hidaka
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuwaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Juichi
authors.initials: J
authors.lastname: Takada
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamino
authors.forename: Masaaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Kokubu
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011169:Portal Vein; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib