title: Post-progression survival and progression-free survival in patients with advanced hepatocellular carcinoma treated by sorafenib.
abstract: OBJECTIVE
  Although sorafenib is a standard drug for advanced hepatocellular carcinoma (HCC), little is known about a patient's clinical course after treatment. We investigated the effect of post-progression survival (PPS) and progression-free survival (PFS) on overall survival (OS) in patients whose advanced HCC was treated by sorafenib.
  
  
  METHODS
  We searched in the PubMed database for reports with survival data of patients with HCC treated with sorafenib monotherapy, and selected reports with 20 or more patients each that provided data for both OS and PFS or time to progression (TTP). Median PPS (mPPS) was defined as the period obtained by subtracting median PFS or TTP (mPFS/TTP) from median OS (mOS). We identified 56 reports with 5803 patients. We investigated the correlation of mOS and either mPPS or mPFS/TTP using weighted linear regression.
  
  
  RESULTS
  Median PPS correlated with mOS (r = 0.834) very strongly, whereas mPFS/TTP did not correlate with mOS as highly as PPS did (r = 0.546). When we stratified survival data by Child-Pugh classification, a significantly greater average percentage of mPPS to mOS was seen in Child-Pugh class A (54.4 ± 17.6%) than in Child-Pugh class B (32.0 ± 11.6%) (P = 0.015).
  
  
  CONCLUSIONS
  PPS highly correlated with OS, and its importance should be more emphasized for advanced HCC patients treated after sorafenib therapy, whereas we need to take more care in interpreting the results of PFS to evaluate treatment efficacy in clinical trials of advanced HCC.
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Terashima
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Takata
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Toyama
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Arai
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Eishiro
authors.initials: E
authors.lastname: Mizukoshi
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Honda
authors.affiliation: Departments of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
keywords: hepatocellular carcinoma; post-progression survival; progression-free survival; sorafenib; subsequent therapy