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Hepatology International

, Volume 11, Issue 3, pp 292–299 | Cite as

Prognostic factors of sorafenib therapy in hepatocellular carcinoma patients with failure of transarterial chemoembolization

  • Sangheun Lee
  • Jung Hyun Kang
  • Do Young KimEmail author
  • Sang Hoon Ahn
  • Jun Yong Park
  • Beom Kyung Kim
  • Seung Up Kim
  • Kwang-Hyub Han
Original Article

Abstract

Background

There is no approved therapy for patients with failed transarterial chemoembolization (TACE) and progression of hepatocellular carcinoma. We aimed to investigate the efficacy and prognostic factors in patients with TACE failure who received sorafenib rescue therapy.

Methods

We investigated 54 patients who met the criteria of TACE failure as defined by the international guidelines of Europe and Japan. Sorafenib was used as a rescue therapy. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier methods, and multivariate analysis was performed to find prognostic factors.

Results

The patients were followed for a median 5.5 months, and the median duration of sorafenib administration was 3.3 months. The presence of main (or lobar) portal vein invasion (PVI) (3.7 versus 8.4 months, p = 0.004), dose reduction of sorafenib (4.0 versus 8.8 months, p = 0.002) and Child-Pugh class B (5.3 versus 8.9 months, p = 0.004) were associated with shorter OS compared to the presence of segmental PVI (or absence of macroscopic vascular invasion, MVI), full dosage of sorafenib and Child-Pugh class A, respectively. The presence of main (or lobar) PVI was associated with poorer PFS compared to the presence of segmental PVI (or absence of MVI) (2.1 versus 3.8 months p = 0.010).

Conclusions

Sorafenib is a potential rescue therapy in patients with TACE failure. However, the clinical benefits need to be further evaluated for patients with main (or lobar) PVI or those treated with reduced doses of sorafenib.

Keywords

Hepatocellular carcinoma Transarterial chemoembolization Sorafenib Prognosis Overall survival 

Abbreviations

HCC

Hepatocellular carcinoma

OS

Overall survival

TACE

Transarterial chemoembolization

AFP

Alpha-fetoprotein

BCLC

Barcelona clinic liver cancer

ECOG PS

Eastern Cooperative Oncology Group performance status

AP

Arterioportal

EHS

Extrahepatic spreading

PVI

Portal vein invasion

MVI

Macroscopic vascular invasion

CT

Computed tomography

MRI

Magnetic resonance imaging

mRECIST

Modified response evaluation criteria in solid tumors

CR

Complete response

PR

Partial response

SD

Stable disease

PD

Progression disease

PFS

Progression-free survival

HR

Hazard ratio

CI

Confidence interval

Notes

Author contribution statement

Do Young Kim and Sangheun Lee participated in the study conception and design. Each author worked on the following tasks: Sangheun Lee, Do Young Kim and Jung Hyun Kang wrote the manuscript. Sang Hoon Ahn and Jun Yong Park collected data and corrected the manuscript. Seung Up Kim and Beom Kyung Kim collected data and participated in study design. Kwang-Hyub Han critically reviewed the manuscript. All authors reviewed and approved the final version of the manuscript to be published.

Compliance with ethical standards

Conflict of interest

Sangheun Lee, Jung Hyun Kang, Do Young Kim, Sang Hoon Ahn, Jun Yong Park, Beom Kyung Kim, Seung Up Kim and Kwang-Hyub Han declare that they have no conflict of interest.

Ethical approval

This study was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. Written informed consent was obtained from each participant or responsible family member after possible complications of the diagnostic procedures and anti-cancer treatments had been fully explained. This study was approved by the independent institutional review board of Severance Hospital.

Supplementary material

12072_2017_9792_MOESM1_ESM.tif (86 kb)
Supplementary Figure 1. Median overall survival according to the MELD score (<19 vs. ≥19) (TIFF 85 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2017

Authors and Affiliations

  • Sangheun Lee
    • 1
    • 2
  • Jung Hyun Kang
    • 3
  • Do Young Kim
    • 3
    Email author
  • Sang Hoon Ahn
    • 3
  • Jun Yong Park
    • 3
  • Beom Kyung Kim
    • 3
  • Seung Up Kim
    • 3
  • Kwang-Hyub Han
    • 3
  1. 1.Department of Internal MedicineCatholic Kwandong University College of Medicine, International St. Mary’s HospitalIncheonRepublic of Korea
  2. 2.Institute for Integrative MedicineCatholic Kwandong University College of Medicine, International St. Mary’s HospitalIncheonRepublic of Korea
  3. 3.Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea

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