title: A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib.
abstract: Sorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR.
  
  
  
  Survival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses.
  
  
  
  After a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis.
  
  
  
  In a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.
authors.affiliation: Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: de la Torre
authors.affiliation: Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Buades-Mateu
authors.affiliation: Preventive Medicine, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: de la Rosa
authors.affiliation: Gastroenterology and Hepatology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
authors.forename: Alberto
authors.identifier: 0000-0002-9672-6038
authors.initials: A
authors.lastname: Lué
authors.affiliation: Liver Unit, Hospital Universitario Cruces, Baracaldo, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Bustamante
authors.affiliation: Gastroenterology and Hepatology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
authors.forename: María T
authors.initials: MT
authors.lastname: Serrano
authors.affiliation: Liver Unit, Hospital Universitario Cruces, Baracaldo, Spain.
authors.forename: Milagros
authors.initials: M
authors.lastname: Testillano
authors.affiliation: Gastroenterology and Hepatology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Lorente
authors.affiliation: Gastroenterology and Hepatology, Hospital Universitario Donostia, San Sebastian, Spain.
authors.forename: Juan I
authors.initials: JI
authors.lastname: Arenas
authors.affiliation: Liver Unit, Hospital Universitario Cruces, Baracaldo, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gil
authors.affiliation: Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.affiliation: Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011169:Portal Vein / Q000473:pathology; D057216:Propensity Score; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D012189:Retrospective Studies; D000077157:Sorafenib; D013030:Spain; D016019:Survival Analysis; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D009536:Niacinamide; D000077157:Sorafenib
keywords: hepatocellular carcinoma; portal vein invasion; radioembolization; selective internal radiation therapy; sorafenib