Retrospective analysis of transarterial chemoembolization and sorafenib in Chinese patients with unresectable and recurrent hepatocellular carcinoma

Abstract

We explored the hypothesis that sorafenib may improve the effect of transarterial chemoembolization (TACE) in patients with recurrent hepatocellular carcinoma (HCC) and that longer sorafenib duration was associated with additional survival benefits. In this retrospective, nested case-controlled study, 1126 cases of unresectable HCC were collected. Patients with unresectable disease treated with TACE+sorafenib (n=245) and TACE alone (n=245) and those with recurrence after surgery treated with TACE+sorafenib (n=127) and TACE alone (n=127) were identified and matched according to sex, age, and lesion size and number. The clinicopathological factors associated with survival were examined by univariate and multivariate analyses. The mean duration of sorafenib treatment was 10.8±10.51 months. Sorafenib significantly increased the median survival time as compared to TACE alone (unresectable HCC: 20.23 vs. 13.97 months, respectively; p=0.013 and recurrent HCC: 30.7 and 18.22 months, respectively; p=0.003). The survival of patients with unresectable HCC was associated with the presence of portal vein tumor thrombus (HR=1.47, p=0.004) and treatment method (TACE+sorafenib combination therapy; HR=0.72, p=0.003). For patients with recurrent HCC, the presence of extrahepatic metastasis (HR=1.71, p=0.012) and treatment method (TACE+sorafenib therapy; HR=0.60, p=0.002) also was associated with survival. For patients treated with TACE+sorafenib, multivariate analysis showed decreased hazard of death with longer duration of sorafenib treatment (HR=0.9, p<0.001). Thus, sorafenib plus TACE may provide survival benefits, which may be related with sorafenib treatment duration, particularly for patients with HCC recurrence. Further clinical studies are required to confirm these results and identify which patients are most likely to benefit from this therapeutic strategy.

Efficacy of Percutaneous Thermal Ablation Combined With Transarterial Embolization for Recurrent Hepatocellular Carcinoma After Hepatectomy and a Prognostic Nomogram to Predict Survival

“…In previous studies, the baseline characteristics of included population showed a prevalence of HBV of about 90% 55 , 56 and a rate of noncirrhosis ranging from 35.4% to 55.1%. 43 , 45 , 56 , 57 It should be noted that, in some area with high prevalence of HCV infection, such as Japan, the rate of patients with rHCC with HBV is only 19.6% to 20.6%. 58 , 59 This may be because of the differences in terms of the geographical distribution, genetics, ethnicity, and different chronic viral infection in patients with HCC.…”

Clinical study of radiofrequency ablation combined with TACE in the treatment of breast cancer with liver metastasis

“…They can combine iodine oil and gelatin sponge with an embolization of tumor blood vessels which control the slow release of chemotherapy drugs. Therefore, the tumor tissue will have hypoxia, necrosis and apoptosis ( 15 ). The median survival period will increase at least 5.0–8.0 months ( 16 ).…”

Thalidomide combined with transcatheter artierial chemoembolzation for primary hepatocellular carcinoma: a systematic review and meta-analysis

“…It is reported that the elevated levels of VEGF and other angiogenic factors secreted by the hypoxic tumor cells after TACE has the role of promoting abnormal angiogenesis [ 11 ]. Indeed, by targeting VEGF, platelet derived growth factor receptor, and other signaling, anti-angiogenesis agents proved to block tumor development and neo-angiogenesis [ 12 , 13 ].…”