Effectiveness of Transarterial Chemoembolization-First Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Abstract

Background Still in real-world practice, advanced hepatocellular carcinoma (HCC) patients are treated with transarterial chemoembolization (TACE). This study compared the therapeutic effectiveness of initial TACE treatment and initial sorafenib treatment in advanced HCC patients. Patient and Methods Advanced HCC patients initially treated with sorafenib or TACE were included in this study. Treatment crossover due to an unfavorable response to initial treatment was allowed. Propensity score (PS) matching was applied for balancing baseline characteristics. The primary outcome was overall survival (OS) and the secondary outcomes included tumor response. Results A total of 554 patients were included in this study: 85 were initially treated with sorafenib (the sorafenib-first group) and 469 with TACE (the TACE-first group). In the entire cohort, the TACE-first group was associated with lower risk of death [adjusted hazard ratio (HR)=0.75, P =0.04]. In the PS-matched cohort (85 patients per group), the TACE-first group showed longer OS than the sorafenib-first group in both univariable (HR=0.68, P =0.02) and multivariable analyses (adjusted HR=0.58, P =0.002). Specifically, within both the entire and the PS-matched cohorts, the TACE-first group showed longer OS in subgroups with major portal vein tumor thrombosis (HR=0.72, P =0.048; HR=0.52, P =0.003) or infiltrative HCC (HR=0.42, P <0.001; HR=0.30, P =0.004, respectively). The objective response rate was higher in the TACE-first group (29.3% vs 14.7%, P =0.03) within the PS-matched cohort. Conclusion For advanced HCC, initial TACE leads to longer OS with a more favorable tumor response than initial sorafenib treatment. Intrahepatic tumor control with initial locoregional therapy may be a potent strategy for advanced HCC.

Prognostic value of preoperative serum ferritin in hepatocellular carcinoma patients undergoing transarterial chemoembolization

“…TACE is considered to cause tumor necrosis by creating a hypoxic environment and producing cytotoxic effects on tumor cells by concentrating high doses of chemotherapy drugs locally on the tumor ( 28 ). TACE can improve the quality of life and extend the survival of patients in intermediate or advanced HCC stages ( 29 , 30 ).…”

Predictors of Hepatic Decompensation after Yttrium90 Transarterial Radioembolization—Optimizing Patient Selection

“…TARE can also be used in patients with portal vein thrombosis while TACE is still considered a relative contraindication in select patients. [3][4][5] Y90 is a pure beta-emitter that achieves its therapeutic effect by inducing DNA damage and subsequent tissue necrosis. 6 HCC receives 80 to 90% of its blood supply from the heaptic artery while normal liver parenchyma is primarily from the portal venous system.…”

“…TARE can also be used in patients with portal vein thrombosis while TACE is still considered a relative contraindication in select patients. 3 4 5…”