title: Early evaluation of response to sorafenib for hepatocellular carcinoma by duplex Doppler ultrasonography.
abstract: OBJECTIVE
  Early evaluation of the response to sorafenib for patients with hepatocellular carcinoma (HCC) remains unclear. This prospective study investigated the early evaluation of the efficacy of sorafenib in patients with advanced HCC using duplex Doppler ultrasonography (DDU).
  
  
  METHODS
  Thirty-seven Child-Pugh class-A advanced HCC patients treated with sorafenib 400 mg b.i.d. were enrolled. Changes in portal venous area (PVA) and portal venous flow velocity (PVV) revealed by DDU before and after 2 weeks of sorafenib treatment were evaluated. The relation between the congestion index (PVA/PVV), which reflects the pathophysiological hemodynamics of the portal venous system and the tumor response, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), was also assessed.
  
  
  RESULTS
  The median progression-free survival and overall survival of all the patients was 2.8 months (95% confidence interval [CI], 2.6-3.2) and 12.8 months (95% CI, 8.7-17.0), respectively. Overall, three patients (8%) had a partial response (PR), 15 (41%) stable disease (SD) and 17 (46%) progressive disease, according to the mRECIST, and two patients (6%) could not be evaluated because of worsened conditions. The decrease in the congestion index was significantly larger in the disease control group (PR/SD) after the sorafenib treatment (P = 0.035); furthermore, the congestion index was the only significant independent predictor of disease control (P = 0.033; hazard ratio, 8.456; 95% CI, 1.182-60.484).
  
  
  CONCLUSIONS
  A decrease in the congestion index revealed by DDU provides an early evaluation of response in patients taking sorafenib for advanced HCC.
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hidaka
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.affiliation: Department of Ultrasonography, Kitasato University East Hospital, Sagamihara, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Department of Ultrasonography, Kitasato University East Hospital, Sagamihara, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Yanagihara
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamino
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Juichi
authors.initials: J
authors.lastname: Takada
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuwaki
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.affiliation: Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
keywords: congestion index; modified Response Evaluation Criteria in Solid Tumors; portal venous area; portal venous flow velocity