Sorafenib Combined with Chemoembolization for Locally Advanced Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score Analysis

Abstract

The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child–Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC.

Effectiveness of c-TACE Combined With Sorafenib Versus c-TACE Monotherapy in Advanced Hepatocellular Carcinoma: A Retrospective Study

“…Moreover, in this study, propensity score matching (PSM) was used to minimize the influence of selection bias and potential confounders, thus reducing the experimental error, which was worthy of recommendation. 19 Park et al 20 found that sorafenib combined with c-TACE significantly improved TTP, PFS, and tumor response rates in advanced HCC patients compared with sorafenib alone, although it did not improve OS. Patients in the trial who received ⩾2 c-TACE treatments had significantly longer survival than those who received sorafenib alone.…”

Yttrium-90 transarterial radioembolization and capecitabine in hepatocellular carcinoma with portal vein involvement

“…[15] One important question regarding the treatment of patients with liver-restricted tumors who are eligible for non-surgical local treatment is whether adding systemic treatment to locoregional treatment improves outcomes. Several retrospective studies [16][17][18][19][20] and ongoing prospective studies have investigated the combined use of TACE and the tyrosine kinase inhibitor sorafenib in patients with advanced disease. [21,22] The results of the first major phase III randomized trial of sorafenib with TARE and SORAMIC have been reported at the 2018 International Liver Congress.…”

Hepatocellular carcinoma with macrovascular invasion: need a personalized medicine for this complicated event

“…In a randomized controlled trial from South Korea ( 10 ), chemoembolization plus external beam radiotherapy showed better median OS than sorafenib treatment (14 vs. 11 months, P=0.04) in HCC patients with MVI. In addition, chemoembolization combined with systemic therapy (sorafenib or lenvatinib) showed promising outcomes in HCC patients with MVI ( 11 , 12 ). Above all, a sizable study regarding clinical outcomes of atezolizumab plus bevacizumab systemic treatment for HCC with MVI is eagerly waited.…”