title: Role of transarterial chemoembolization in relation with sorafenib for patients with advanced hepatocellular carcinoma.
abstract: BACKGROUND
  Although sorafenib is considered standard therapy for advanced hepatocellular carcinoma (HCC), actual treatments vary. We evaluated the effects of different treatment strategies on overall survival.
  
  
  METHODS
  A retrospective study of sorafenib-treated patients with advanced HCC was conducted. The primary outcome was overall survival. Prognostic factors were analyzed using multivariate Cox-proportional hazards model.
  
  
  RESULTS
  A total of 658 patients (mean age, 54.5 years; 83.3% male) were analyzed; 293, 129, and 236 patients were treated with sorafenib, a combination therapy of sorafenib and transarterial chemoembolization (TACE), and TACE followed by sorafenib, respectively. Overall, 51.2% of patients treated under the combination strategy had portal vein invasion, whereas 89.9% of patients receiving sorafenib monotherapy had distant metastasis. Median overall survival durations were comparable (11.8 months for sorafenib, 16.2 months for the combination therapy, and 13.5 months for TACE followed by sorafenib; P = 0.13). However, among portal vein invasion cases, combination (25.7 months, P = 0.002) and TACE followed by sorafenib (14.0 months, P = 0.030) treatments were associated with longer overall survival duration compared with than sorafenib monotherapy (5.5 months). In a multivariate model, sorafenib duration (hazard ratio [HR], 0.96, P < 0.001) and TACE (HR, 0.24, P < 0.001) along with Child-Pugh stage (HR, 1.83, P = 0.005) were associated with better survival.
  
  
  CONCLUSIONS
  In patients with portal vein invasion, TACE performed concurrently with or before sorafenib administration is associated with better survival.
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.|Department of Gastroenterology, CHA Bundang Medical Center, CHA University, Republic of Korea.
authors: Yeonjung
authors: Y
authors: Ha
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Danbi
authors: D
authors: Lee
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Ju Hyun
authors: JH
authors: Shim
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Young-Suk
authors: YS
authors: Lim
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Han Chu
authors: HC
authors: Lee
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Young-Hwa
authors: YH
authors: Chung
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Yung Sang
authors: YS
authors: Lee
authors: Department of Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Sook Ryun
authors: SR
authors: Park
authors: Department of Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Min-Hee
authors: MH
authors: Ryu
authors: Department of Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Baek-Yeol
authors: BY
authors: Ryoo
authors: Department of Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Yoon-Koo
authors: YK
authors: Kang
authors: Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
authors: Kang Mo
authors: KM
authors: Kim
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077157:Sorafenib; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib
keywords: hepatocellular carcinoma; overall survival; portal vein invasion; sorafenib; transarterial chemoembolization