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Sorafenib combined with transarterial chemoembolization versus transarterial chemoembolization alone for advanced-stage hepatocellular carcinoma: a propensity score matching study.

Hu H, Duan Z, Long X, Hertzanu Y, Shi H, Liu S, Yang Z - PLoS ONE (2014)

Bottom Line: In the propensity-score-matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003).Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05).Sorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

ABSTRACT

Aims: The purpose of the present study was to compare the efficacies of transarterial chemoembolization (TACE) combined with sorafenib versus TACE monotherapy for treating patients with advanced hepatocellular carcinoma (HCC).

Methods: We enrolled 321 patients and selected 280 with advanced HCC (Barcelona Clinic Liver Cancer stage C) who underwent TACE therapy between February 2009 and February 2013. TACE alone (monotherapy group) was administered to 198 patients (70.7%), and the remaining 82 (29.3%) underwent repeat combined TACE and sorafenib therapy (combined group). To minimize selection bias, these latter 82 patients were matched using propensity-score matching at a 1∶2 ratio with 164 patients who received TACE monotherapy. The primary endpoints were overall survival (OS) and related subgroup analysis. The secondary endpoints were time to progression (TTP) and treatment-related adverse events.

Results: Of the respective patients in the combined and monotherapy groups, 64.6% and 49.2% had vascular invasion, 87.8% and 91.1% had extrahepatic metastasis, and 54.3% and 47.1% had both. In the propensity-score-matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003). The TTP was significantly longer in the combined group (2.6 months vs. 1.9 months, respectively, P = 0.001). Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05). Univariate and subsequent multivariate analyses revealed that the addition of sorafenib was an independent predictor of favorable OS and TTP (adjusted hazard ratios, 0.63 and 0.62, respectively; P<0.05 for both).

Conclusion: Sorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion. Future trials with larger samples are required to validate these preliminary findings.

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Kaplan–Meier analysis of overall survival of subgroups of the combined group.As shown in Figure 3, two subgroups showed significantly improved OS (the group of patients with portal vein branch thrombosis without tumor extrahepatic metastasis) compared with patients with portal vein thrombosis and tumor extrahepatic metastasisas follows: HR, 0.34; 95%CI, 0.16–0.73; P  = 0.005; Statistical data for the group of patients with tumor extrahepatic metastasis without portal vein thrombosis are as follows: HR, 0.46; 95%CI, 0.23–0.91; P  = 0.027). However, combined therapy did not significantly improve OS of the group with main portal vein thrombosis without tumor extrahepatic metastasis (HR, 1.07; 95%CI 0.54–2.13; P  = 0.848).
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pone-0096620-g003: Kaplan–Meier analysis of overall survival of subgroups of the combined group.As shown in Figure 3, two subgroups showed significantly improved OS (the group of patients with portal vein branch thrombosis without tumor extrahepatic metastasis) compared with patients with portal vein thrombosis and tumor extrahepatic metastasisas follows: HR, 0.34; 95%CI, 0.16–0.73; P  = 0.005; Statistical data for the group of patients with tumor extrahepatic metastasis without portal vein thrombosis are as follows: HR, 0.46; 95%CI, 0.23–0.91; P  = 0.027). However, combined therapy did not significantly improve OS of the group with main portal vein thrombosis without tumor extrahepatic metastasis (HR, 1.07; 95%CI 0.54–2.13; P  = 0.848).

Mentions: In the combined group, patients were divided into four groups according to the extent of portal vein invasion and/or extrahepatic metastasis (Table 3). The median survival time of patients with main portal vein thrombosis (MPVT) without TEM was 5.8 months (Figure 3). Compared with patients with PVT and TEM, the OS of this group did not significantly improve (HR, 1.07; 95%CI, 0.54–2.13, P = 0.848). The median survival time of patients with portal vein branch thrombosis (PVBT) without TEM was 7.5 months. Compared with patients with PVT and TEM, the OS of this group was significantly improved (HR, 0.34; 95%CI, 0.16–0.73; P = 0.005).The median survival time was 8.0 months for patients with TEM without PVT. The OS of this group was significantly improved compared with patients with PVT and TEM (HR, 0.46; 95%CI, 0.23–0.91, P = 0.027). The median survival time was 3.5 months for patients with PVT and TEM.


Sorafenib combined with transarterial chemoembolization versus transarterial chemoembolization alone for advanced-stage hepatocellular carcinoma: a propensity score matching study.

Hu H, Duan Z, Long X, Hertzanu Y, Shi H, Liu S, Yang Z - PLoS ONE (2014)

Kaplan–Meier analysis of overall survival of subgroups of the combined group.As shown in Figure 3, two subgroups showed significantly improved OS (the group of patients with portal vein branch thrombosis without tumor extrahepatic metastasis) compared with patients with portal vein thrombosis and tumor extrahepatic metastasisas follows: HR, 0.34; 95%CI, 0.16–0.73; P  = 0.005; Statistical data for the group of patients with tumor extrahepatic metastasis without portal vein thrombosis are as follows: HR, 0.46; 95%CI, 0.23–0.91; P  = 0.027). However, combined therapy did not significantly improve OS of the group with main portal vein thrombosis without tumor extrahepatic metastasis (HR, 1.07; 95%CI 0.54–2.13; P  = 0.848).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016022&req=5

pone-0096620-g003: Kaplan–Meier analysis of overall survival of subgroups of the combined group.As shown in Figure 3, two subgroups showed significantly improved OS (the group of patients with portal vein branch thrombosis without tumor extrahepatic metastasis) compared with patients with portal vein thrombosis and tumor extrahepatic metastasisas follows: HR, 0.34; 95%CI, 0.16–0.73; P  = 0.005; Statistical data for the group of patients with tumor extrahepatic metastasis without portal vein thrombosis are as follows: HR, 0.46; 95%CI, 0.23–0.91; P  = 0.027). However, combined therapy did not significantly improve OS of the group with main portal vein thrombosis without tumor extrahepatic metastasis (HR, 1.07; 95%CI 0.54–2.13; P  = 0.848).
Mentions: In the combined group, patients were divided into four groups according to the extent of portal vein invasion and/or extrahepatic metastasis (Table 3). The median survival time of patients with main portal vein thrombosis (MPVT) without TEM was 5.8 months (Figure 3). Compared with patients with PVT and TEM, the OS of this group did not significantly improve (HR, 1.07; 95%CI, 0.54–2.13, P = 0.848). The median survival time of patients with portal vein branch thrombosis (PVBT) without TEM was 7.5 months. Compared with patients with PVT and TEM, the OS of this group was significantly improved (HR, 0.34; 95%CI, 0.16–0.73; P = 0.005).The median survival time was 8.0 months for patients with TEM without PVT. The OS of this group was significantly improved compared with patients with PVT and TEM (HR, 0.46; 95%CI, 0.23–0.91, P = 0.027). The median survival time was 3.5 months for patients with PVT and TEM.

Bottom Line: In the propensity-score-matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003).Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05).Sorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

ABSTRACT

Aims: The purpose of the present study was to compare the efficacies of transarterial chemoembolization (TACE) combined with sorafenib versus TACE monotherapy for treating patients with advanced hepatocellular carcinoma (HCC).

Methods: We enrolled 321 patients and selected 280 with advanced HCC (Barcelona Clinic Liver Cancer stage C) who underwent TACE therapy between February 2009 and February 2013. TACE alone (monotherapy group) was administered to 198 patients (70.7%), and the remaining 82 (29.3%) underwent repeat combined TACE and sorafenib therapy (combined group). To minimize selection bias, these latter 82 patients were matched using propensity-score matching at a 1∶2 ratio with 164 patients who received TACE monotherapy. The primary endpoints were overall survival (OS) and related subgroup analysis. The secondary endpoints were time to progression (TTP) and treatment-related adverse events.

Results: Of the respective patients in the combined and monotherapy groups, 64.6% and 49.2% had vascular invasion, 87.8% and 91.1% had extrahepatic metastasis, and 54.3% and 47.1% had both. In the propensity-score-matched cohort, the OS survival of the combined group was significantly higher compared with the monotherapy group (7.0 months vs. 4.9 months, respectively, P = 0.003). The TTP was significantly longer in the combined group (2.6 months vs. 1.9 months, respectively, P = 0.001). Subgroup analysis showed that the outcomes of patients with advanced HCC without main portal vein invasion who were treated with combined therapy were significantly better compared with those who received monotherapy (P<0.05). Univariate and subsequent multivariate analyses revealed that the addition of sorafenib was an independent predictor of favorable OS and TTP (adjusted hazard ratios, 0.63 and 0.62, respectively; P<0.05 for both).

Conclusion: Sorafenib plus TACE was more effective than TACE monotherapy for treating patients with advanced HCC without main portal vein invasion. Future trials with larger samples are required to validate these preliminary findings.

Show MeSH
Related in: MedlinePlus