Resection vs. Sorafenib for Hepatocellular Carcinoma With Macroscopic Vascular Invasion: A Real World, Propensity Score Matched Analytic Study

Abstract

Background: Macroscopic vascular invasion (MVI) commonly occurs in patients with advanced hepatocellular carcinoma (HCC) for which resection and sorafenib are the common therapies prescribed. Here, we aimed to compare the survival outcomes of these two therapies in HCC patients with MVI. Methods: In total, 496 patients diagnosed with HCC and MVI without extrahepatic metastasis, treated with resection (resection-based group, n = 388) and sorafenib (sorafenib-based group, n = 108) were included in this study. A one-to-one propensity score-matching analysis (PSM) was performed to minimize the effect of potential confounders. Results: The median OS in the resection-and sorafenib-based group was 20.7 months (95% CI: 16.9-24.5) and 11.6 months (95% CI: 8.4-14.9) (p < 0.001), respectively. The median PFS was 4.7 months (95% CI: 3.8-5.5) in the resection-based group and 4.4 months (95% CI: 3.6-5.2) in the sorafenib-based group (p < 0.001). After PSM, 72 patients from each group were matched. The median OS was 27.2 months (95% CI: 16.4-38.0) in the resection-based group and 13.0 months (95% CI: 9.6-16.3) in the sorafenib-based group (p < 0.001). The median PFS was 5.3 months (95% CI: 3.2-7.4) in the resection-based group and 4.8 months (95% CI: 3.6-6.0) in the sorafenib-based group (p = 0.061). Conclusion: Findings from this study showed that, compared with sorafenib-based treatment, surgical resection might be associated with better survival benefits to HCC patients with MVI.

Secondarily estimated cure fraction and five-year recurrence-free conditional survival probabilities among patients undergoing surgical resection for hepatocellular carcinoma presenting with minor gross vascular invasion

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Fig. 2 Reconstructed Kaplan–Meier (KM) survival curves among two groups according to minor gross vascular invasion (mGVI) secondarily from original KM data using the algorithm of Guyot P et al [ 13 ]

Fig. 3 Predicted recurrence-free survival by cure model analysis in both the no-GVI group ( a ) and the mGVI group ( b )

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“… Reconstructed Kaplan–Meier (KM) survival curves among two groups according to minor gross vascular invasion (mGVI) secondarily from original KM data using the algorithm of Guyot P et al [ 13 ] …”

“…Although the standard practical guideline recommends systemic therapy for the treatment of HCC presenting with GVI, [ 7 ] the efficacy of SR when applied in clinical practice has been still investigated. Most of the clinical studies regarding this issue have been focused on the relative outcomes of SR for HCC with GVI compared with other treatment modalities, especially transarterial chemoembolization or sorafenib [ 13 , 14 ]. These studies also showed that the comparative effectiveness of SR is more noticeable in treating HCC presenting with mGVI than that in HCC with major GVI.…”

“…For patients Fig. 2 Reconstructed Kaplan-Meier (KM) survival curves among two groups according to minor gross vascular invasion (mGVI) secondarily from original KM data using the algorithm of Guyot P et al [13] Fig. 3 Predicted recurrence-free survival by cure model analysis in both the no-GVI group (a) and the mGVI group (b) in the no-GVI group and the mGVI group, the corresponding 5-year RFCS probabilities were 36.2% and 35.5% at the first year, and 50.2% and 44.8% at the fifth year, respectively.…”

“…The current Barcelona Clinic for Liver Cancer staging system recommends a systemic therapy with sorafenib at this stage, but the outcome has not been promising for patients with HCC presenting with GVI [ 11 ]. Recent studies by experienced surgeons asserted that SR provided superior treatment outcomes compared to other treatment modalities, such as transarteiral chemoembolization or sorafenib, for patients with HCC presenting with GVI [ 12 , 13 ]. Systemic reviews and meta-analyses supporting the outcomes of these studies were also found [ 14 ].…”