Zhexuan Wang1, Enxin Wang1, Wei Bai1, Dongdong Xia1, Rong Ding2, Jiaping Li3, Qiuhe Wang1, Lei Liu1, Junhui Sun4, Wei Mu5, Hui Zhao6, Xingnan Pan7, Guoliang Shao8, Xiaoli Zhu9, Guowen Yin10, Haibin Shi11, Jianbing Wu12, Zhengyu Lin13, Shufa Yang14, Jueshi Liu15, Wenhui Wang16, Xu Zhu17, Yong Lv1, Jing Li1, Hui Chen1, Wenjun Wang1, Kai Li1, Xulong Yuan1, Tanlei Yu1, Jie Yuan1, Xiaomei Li1, Jing Niu1, Zhanxin Yin1, Jielai Xia18, Daiming Fan1,19, Guohong Han1. 1. Department of Liver Disease and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China. 2. Department of Minimally Invasive International Therapy, the Third Affiliated Hospital of Kunming University, Tumor Hospital of Yunnan province, Kunming, China. 3. Department of Interventional Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 4. Department of Hepatobiliary and Pancreatic Interventional Cancer, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 5. Department of Radiology, the Southwest Hospital, Third Military Medical University, Chongqing, China. 6. Department of Interventional Radiology, the Affiliated Hospital of Nantong University, Nantong, China. 7. Clinical Liver Diseases Research Center, Nanjing Military Command, 180th Hospital of PLA, Quanzhou, China. 8. Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China. 9. Department of Interventional Radiology, the First Affiliated Hospital of Soochow University, Suzhou, China. 10. Department of Interventional Radiology, Jiangsu Provincial Cancer Hospital, the Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China. 11. Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 12. Department of Oncology, the Second Affiliated Hospital of Nanchang University, Nanchang, China. 13. Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China. 14. Department of Interventional Radiology, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China. 15. Department of Interventional Radiology and Vascular Surgery, Hunan Provincial People's Hospital, Changsha, China. 16. Department of Interventional Medicine, the First Affiliated Hospital of Lanzhou University, Lanzhou, China. 17. Department of Interventional Radiology, Peking University Cancer Hospital, Beijing, China. 18. Department of Medical Statistics, Fourth Military Medical University, Xi'an, China. 19. Xijing Hospital of Digestive Diseases and State Key Laboratory of Cancer Biology, Fourth Military Medical University, Xi'an, China.
Abstract
INTRODUCTION: The benefits of combining transarterial chemoembolization (TACE) and sorafenib (TACE-S) over TACE alone for treatment of unresectable hepatocellular carcinoma (HCC) remain controversial. Yet, such populations are heterogeneous in terms of baseline characteristics. OBJECTIVE: To investigate the predictors of survival benefits from added sorafenib and identify the potential candidates for TACE-S. METHODS: This multicenter observational study was conducted in 17 Chinese tertiary hospitals for patients with unresectable, liver-confined HCC. Eligible patients with performance status score of ≤1 and Child-Pugh score of ≤7 were treated with TACE or TACE-S. Interactions between treatment and baseline variables were evaluated to find indicators for survival benefits, based on which the patients were stratified. Multivariate models adjusted for baseline characteristics or propensity score were used to compare overall survival (OS) and time to tumor progression (TTP). RESULTS: From January 2009 to December 2015, 1,719 consecutive patients received TACE (n = 1,406) or TACE-S (n = 313). Although TACE-S compared with TACE improved TTP (adjusted hazard ratio [HR] 0.75, p = 0.008), no difference in OS was observed (adjusted HR 0.87, p = 0.090). Nevertheless, the tumor burden (sum of maximum diameter of largest tumor [cm] and tumor number) and albumin-bilirubin (ALBI) score independently predicted the survival benefits from added sorafenib (interaction p< 0.001). For patients with either moderate tumor burden (7-13) or low ALBI score (no more than -2.8) defined as candidates, TACE-S prolonged OS (adjusted HR 0.73, p = 0.003) and TTP (adjusted HR 0.72, p = 0.014) compared to TACE alone, whereas its superiority disappeared in non-candidates. CONCLUSIONS: Not all unresectable HCC patients but those with moderate tumor burden or low ALBI score achieve survival benefits from TACE-S compared with TACE alone. Future randomized controlled trials focusing on the subset are warranted.
INTRODUCTION: The benefits of combining transarterial chemoembolization (TACE) and sorafenib (TACE-S) over TACE alone for treatment of unresectable hepatocellular carcinoma (HCC) remain controversial. Yet, such populations are heterogeneous in terms of baseline characteristics. OBJECTIVE: To investigate the predictors of survival benefits from added sorafenib and identify the potential candidates for TACE-S. METHODS: This multicenter observational study was conducted in 17 Chinese tertiary hospitals for patients with unresectable, liver-confined HCC. Eligible patients with performance status score of ≤1 and Child-Pugh score of ≤7 were treated with TACE or TACE-S. Interactions between treatment and baseline variables were evaluated to find indicators for survival benefits, based on which the patients were stratified. Multivariate models adjusted for baseline characteristics or propensity score were used to compare overall survival (OS) and time to tumor progression (TTP). RESULTS: From January 2009 to December 2015, 1,719 consecutive patients received TACE (n = 1,406) or TACE-S (n = 313). Although TACE-S compared with TACE improved TTP (adjusted hazard ratio [HR] 0.75, p = 0.008), no difference in OS was observed (adjusted HR 0.87, p = 0.090). Nevertheless, the tumor burden (sum of maximum diameter of largest tumor [cm] and tumor number) and albumin-bilirubin (ALBI) score independently predicted the survival benefits from added sorafenib (interaction p< 0.001). For patients with either moderate tumor burden (7-13) or low ALBI score (no more than -2.8) defined as candidates, TACE-S prolonged OS (adjusted HR 0.73, p = 0.003) and TTP (adjusted HR 0.72, p = 0.014) compared to TACE alone, whereas its superiority disappeared in non-candidates. CONCLUSIONS: Not all unresectable HCC patients but those with moderate tumor burden or low ALBI score achieve survival benefits from TACE-S compared with TACE alone. Future randomized controlled trials focusing on the subset are warranted.
Authors: Julie K Heimbach; Laura M Kulik; Richard S Finn; Claude B Sirlin; Michael M Abecassis; Lewis R Roberts; Andrew X Zhu; M Hassan Murad; Jorge A Marrero Journal: Hepatology Date: 2018-01 Impact factor: 17.425
Authors: Ghassan K Abou-Alfa; Dino Amadori; Armando Santoro; Arie Figer; Jacques De Greve; Chetan Lathia; Dimitris Voliotis; Sibyl Anderson; Marius Moscovici; Sergio Ricci Journal: Gastrointest Cancer Res Date: 2011-03
Authors: Philip J Johnson; Sarah Berhane; Chiaki Kagebayashi; Shinji Satomura; Mabel Teng; Helen L Reeves; James O'Beirne; Richard Fox; Anna Skowronska; Daniel Palmer; Winnie Yeo; Frankie Mo; Paul Lai; Mercedes Iñarrairaegui; Stephen L Chan; Bruno Sangro; Rebecca Miksad; Toshifumi Tada; Takashi Kumada; Hidenori Toyoda Journal: J Clin Oncol Date: 2014-12-15 Impact factor: 44.544
Authors: Luigi Bolondi; Andrew Burroughs; Jean-François Dufour; Peter R Galle; Vincenzo Mazzaferro; Fabio Piscaglia; Jean Luc Raoul; Bruno Sangro Journal: Semin Liver Dis Date: 2013-02-08 Impact factor: 6.115