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The PPRD score stratifies patients with hepatocellular carcinoma and portal vein tumor thrombus treated with sorafenib plus transarterial chemoembolization

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To identify clinical prognostic and predictive factors in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) undergoing sorafenib plus transarterial chemoembolization (TACE) and establish a prognostic score for these patients.

Methods

Between January 2012 and December 2017, 184 consecutive patients with HCC and PVTT were concurrently treated with sorafenib and TACE. Univariate and multivariate analyses were performed to explore the clinical factors independently correlated with overall survival (OS). A prognostic score was then developed to identify different prognoses in an initial cohort and validated in an external cohort (n = 72).

Results

In the multivariate analysis, performance status, extension of PVTT, initial radiological response, and sorafenib-related dermatologic toxicity were identified as predictors associated with OS. These factors were used to develop a prognostic score (PPRD score, range from 0 to 11). The median survival was found to decrease as the PPRD score increased, and patients were stratified into a favorable group (0 points), intermediate group (1–4 points), and dismal group (> 4 points). The median survival of patients in the three groups was 34.0 months, 20.0 months, and 7.0 months, respectively (p < 0.001). Additionally, the time to progression (TTP) (p < 0.001) was stratified along the same prognostic groups. The external validation cohort confirmed the prognostic scores.

Conclusions

The proposed score system can accurately stratify the outcomes of patients with HCC and PVTT treated with sorafenib plus TACE to help identify which group of patients may benefit from treatment.

Key Points

• The survival benefits of patients with advanced HCC treated with sorafenib plus TACE remains controversial.

• The independent factors associated with survival were identified to develop a prognostic score, called the PPRD score (standing for performance status, PVTT grade, radiological response, and sorafenib-related dermatologic toxicity); the median survival decreases as the score increases.

• The scoring system can accurately stratify the survival benefits of patients with HCC and PVTT treated with combination therapy and help to identify which group of patients may benefit from the treatment.

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Abbreviations

AE:

Adverse event

AFP:

Alpha-fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

CI:

Confidence interval

CR:

Complete response

CT:

Computed tomography

CTCAE:

Common Terminology Criteria for Adverse Events

EASL:

European Association for the Study of the Liver

ECOG:

Eastern Cooperative Oncology Group

HCC:

Hepatocellular carcinoma

HFSR:

Hand-foot-skin reactions

HR:

Hazard ratio

mRECIST:

modified Response Evaluation Criteria in Solid Tumors

MRI:

Magnetic resonance imaging

OS:

Overall survival

PD:

Progressive disease

PR:

Partial response

PVTT:

Portal vein tumor thrombus

SD:

Stable disease

TACE:

Transarterial chemoembolization

TTP:

Time to progression

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Acknowledgments

We would like to thank Shiting Feng (Department of Radiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China) for imaging assistance, and Jinjian Chen (School of Public Health, Southern Medical University, Guangzhou, China) for statistical assistance in the manuscript.

Funding

The authors state that this work has not received any funding.

Author information

Author notes

  1. Yingqiang Zhang and Hongfei Miao contributed equally to this work.

Authors and Affiliations

  1. Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, People’s Republic of China

    Yingqiang Zhang, Hongfei Miao & Yong Chen

  2. Department of Interventional Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China

    Yingqiang Zhang

  3. Department of Pathology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China

    Wenlin Xie

  4. Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China

    Suxiang Jiang

  5. Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China

    Ze Song

  6. Digestive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, People’s Republic of China

    Guihua Huang

  7. Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, People’s Republic of China

    Wenzhe Fan, Yu Wang & Jiaping Li

Authors
  1. Yingqiang Zhang
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Corresponding authors

Correspondence to Jiaping Li or Yong Chen.

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Guarantor

The scientific guarantor of this publication is Yong Chen (Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China).

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Jinjian Chen (School of Public Health, Southern Medical University, Guangzhou, China) kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have not been previously reported.

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• retrospective

• observational

• multicenter study/performed at two institution

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Zhang, Y., Miao, H., Xie, W. et al. The PPRD score stratifies patients with hepatocellular carcinoma and portal vein tumor thrombus treated with sorafenib plus transarterial chemoembolization. Eur Radiol 31, 232–243 (2021). https://doi.org/10.1007/s00330-020-07078-z

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