title: The effect of locoregional therapies in patients with advanced hepatocellular carcinoma treated with sorafenib.
abstract: It is unknown whether the addition of locoregional therapies (LRTx) to sorafenib improves prognosis over sorafenib alone in patients with advanced hepatocellular carcinoma (HCC). The aim of this study was to assess the effect of LRTx in this population.
  
  
  
  A retrospective analysis was performed of patients with advanced HCC as defined by extrahepatic metastasis, lymphadenopathy >2 cm, or gross vascular invasion. Sorafenib therapy was required for inclusion. Survival of patients who received LRTx after progression to advanced stage was compared to those who did not receive LRTx.
  
  
  
  Using an intention to treat analysis of 312 eligible patients, a propensity weighted proportional hazards model demonstrated LRTx as a predictor of survival (HR = 0.505, 95% CI: 0.407-0.628; P < 0.001). The greatest benefit was seen in patients with the largest tumor burden (HR = 0.305, 95% CI: 0.236-0.393; P < 0.01). Median survival in the sorafenib arm was 143 days (95% CI: 118-161) vs. 247 days (95% CI: 220-289) in the sorafenib plus LRTx arm (P < 0.001).
  
  
  
  These results demonstrate a survival benefit with the addition of LRTx to sorafenib for patients with advanced HCC. These findings should prompt a prospective clinical trial to further assess the role of LRTx in patients with advanced HCC.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: umut.sarpel@mountsinai.org.
authors.forename: Umut
authors.initials: U
authors.lastname: Sarpel
authors.affiliation: Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Spivack
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Berger
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Heskel
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Samantha N
authors.initials: SN
authors.lastname: Aycart
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Sweeney
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Edwards
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Labow
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009536:Niacinamide / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib