Prognostic factors of sorafenib therapy in hepatocellular carcinoma patients with failure of transarterial chemoembolization
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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.
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.
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).
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.
KeywordsHepatocellular carcinoma Transarterial chemoembolization Sorafenib Prognosis Overall survival
Barcelona clinic liver cancer
- ECOG PS
Eastern Cooperative Oncology Group performance status
Portal vein invasion
Macroscopic vascular invasion
Magnetic resonance imaging
Modified response evaluation criteria in solid tumors
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.
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.
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