186P - Efficacy and safety of sorafenib following hepatic resection in patients with hepatocellular carcinoma: A meta-analysis

Background

Sorafenib is a multikinase inhibitor used to treat patients with unresectable hepatocellular carcinoma (HCC); however, there is no consensus on its efficacy in patients with HCC post hepatic resection. Therefore, this meta-analysis (PROSPERO ID: CRD42019122147) assessed efficacy and safety of sorafenib in patients with HCC who underwent hepatic resection.

Methods

Using PICO framework, relevant articles were retrieved from PubMed, EMBASE, Cochrane Library and Google Scholar. Articles comparing outcomes of sorafenib treated patients with HCC who underwent resection with those not receiving sorafenib were included for the analysis The primary outcome was overall survival (OS) while disease free survival (DFS), tumor recurrence rate (TRR), mortality and safety were the secondary outcomes. Hazard ratio (HR) or risk ratio (RR) along with 95% confidence interval (CI) were calculated by fixed or random effects (FE or RE) model, based on the heterogeneity. P < 0.05 was considered significant. The effect of portal vein tumor thrombosis (PVTT) and time of initiation of sorafenib therapy on survival were assessed by subgroup analysis.

Results

A total of 10 studies with data of 589 patients (mean age 52.41 years; men: 87.28%; women: 12.72%) were included in the analysis. Sorafenib significantly prolonged OS (n = 5; FE; HR: 0.69; 95% CI; 0.52, 0.93; P =.0139), reduced TRR (n = 8; FE; RR: 0.91; 95% CI: 0.83, 0.98; P =.0187) and mortality (n = 7; FE; RR: 0.75; 95% CI: 0.63, 0.88; P =.0007) in patients with HCC following hepatic resection compared to the control group. Further, DFS in the sorafenib group was non-significantly better than the control group (n = 5; FE; HR: 0.78; 95% CI: 0.56, 1.09; P =.1462). Although, the proportion of adverse events (AEs) was higher in the sorafenib group (81.1% vs 18.9%), the AEs were tolerable. Subgroup analysis revealed sorafenib to be more effective (lower TRR and mortality) in patients without PVTT than those with PVTT.

Conclusions

Adjuvant sorafenib treatment improved survival outcomes in HCC patients post hepatic resection and had acceptable safety profile. Hence, sorafenib could be recommended as an adjuvant therapy for patients with HCC after hepatic resection.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Science Fund for Creative Research Groups, NSFC, China (81521091); State key infection disease project of China (2018ZX10732202-002-005); National Human Genetic Resources Sharing Service Platform (2005DKA21300);.

Disclosure

All authors have declared no conflicts of interest.