title: Enhanced therapeutic efficacy of combined use of sorafenib and transcatheter arterial chemoembolization for treatment of advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  Clinical trials suggest that combining transcatheter arterial chemoembolization with sorafenib in patients with advanced hepatocellular carcinoma shows a superior safety and tolerability profile. Our study aimed to retrospectively analyze the utility and prognostic factors of this combined therapy in these patients.
  
  
  METHODS
  Patients with advanced hepatocellular carcinoma, treated by transcatheter arterial chemoembolization and sorafenib subsequently, between February 2010 and September 2012 in our hospital, were retrospectively analyzed. After sorafenib treatment for 12 weeks, abdominal enhanced computed tomography or magnetic resonance imaging was used to evaluate short-term outcomes and clinical benefit rate. Overall survival and adverse events were recorded during follow-up. Univariate and multivariate analyses were used to identify relationships between baseline characteristics and overall survival.
  
  
  RESULTS
  Fifty-one advanced hepatocellular carcinoma patients were included. Common adverse events for sorafenib were hand-foot skin reaction, alopecia, diarrhea, anorexia and fatigue. The clinical benefit rate was 64% and the median survival time was 7.5 months. Median survival of patients with and without portal vein tumor thrombi was 6.0 months and 10.3 months (P < 0.001), respectively. Median survival of patients with cholinesterase ≥5000 U/l and < 5000 U/l was 10.6 months and 6.1 months (P < 0.001), respectively. Multivariate analysis identified the presence of portal vein tumor thrombi and low cholinesterase level as independent negative predictors of survival.
  
  
  CONCLUSIONS
  Combining sorafenib and transcatheter arterial chemoembolization was safe and effective for advanced hepatocellular carcinoma patients with extrahepatic spread but without portal vein tumor thrombi. Portal vein tumor thrombi and cholinesterase level are independent predictors of prognosis following this combined therapy.
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Ding-Lun
authors.initials: DL
authors.lastname: Ai
authors.affiliation: Research Center for Biological Therapy, Beijing 302 Hospital, Beijing, China.
authors.forename: Jun-Liang
authors.initials: JL
authors.lastname: Fu
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Xiao-Ming
authors.initials: XM
authors.lastname: Peng
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Lin-Zhi
authors.initials: LZ
authors.lastname: Zhang
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Jing-Yan
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yu
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing.
authors.forename: Chun-Zi
authors.initials: CZ
authors.lastname: Liu
authors.affiliation: Department of Interventional Radiology, Beijing 302 Hospital, Beijing hmw302@sohu.com.
authors.forename: Hua-Ming
authors.initials: HM
authors.lastname: Wang
mesh_terms: D000328:Adult; D000505:Alopecia / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000077157:Sorafenib; D054556:Venous Thromboembolism / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: cholinesterase; hepatocellular carcinoma; sorafenib; transcatheter arterial chemoembolization