Overall survival in response to sorafenib with transarterial chemoembolization for BCLC stage B hepatocellular carcinoma: propensity score analysis .
OBJECTIVE
Barcelona clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) is a heterogeneous disease group. Transarterial chemoembolization (TACE) is indicated for BCLC stage B HCC, while sorafenib is indicated for BCLC stage C HCC. This study aimed to evaluate the efficacy of TACE+sorafenib compared with TACE monotherapy in the treatment of BCLC stage B HCC.


METHODS
Patients with BCLC stage B unresectable HCC.


METHODS
This was a retrospective study in patients with BCLC stage B HCC who received TACE (n = 144) or TACE+sorafenib (n = 46) between January 2008 and January 2014. Child-Pugh classification, history of hepatitis or cirrhosis, nodule number, tumor vascularity, ECOG performance status, adverse events, and survival were evaluated. Patients were matched 1 : 1 using the propensity score approach.


RESULTS
Median overall survival (OS) was 18.0 months in the TACE+sorafenib group compared with 10.0 months for TACE (p = 0.002). In matched patients, multivariate analysis showed that the use of TACE+sorafenib (HR = 0.351, 95%CI: 0.215-0.574, p < 0.001) and multiple-diffuse nodules (HR = 0.497, 95% CI: 0.293 - 0.884, p = 0.010) were independently associated with a better prognosis. Subgroup analysis showed survival benefits for patients with Child-Pugh A classification (p = 0.001), cirrhosis (p = 0.001), hepatitis B (p < 0.001), hypovascular lesion (p = 0.001), and both single/multiple nodules p = 0.001). Cumulative rates of adverse events were similar between the two groups (p = 0.155), but hand-foot syndrome (58.7% vs. 12.5%, p < 0.001) and diarrhea (60.9% vs. 40.3%, p = 0.02) were more frequent in the TACE+sorafenib group.


CONCLUSIONS
The combination of TACE+sorafenib might improve the OS of patients with BCLC stage B HCC. These results also suggest that some subsets of patients could benefit more from the TACE+sorafenib combination. .
Yonghui
Y
Huang
Bin
B
Chen
Ni
N
Liu
Nan
N
Li
Haitao
H
Dao
Wei
W
Chen
Jianyong
J
Yang
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D057216:Propensity Score; D000077157:Sorafenib
D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib