We explored the hypothesis that the addition of sorafenib may have the potential to improve the effect of transarterial chemoembolization (TACE) in patients with recurrent hepatocellular carcinoma (HCC).
Of 1126 cases of unresectable HCC retrospectively collected, patients with unresectable disease treated with TACE + sorafenib (n = 245) or TACE alone (n = 245) as well as those with recurrence after surgery treated with TACE + sorafenib (n = 127) or TACE alone (n = 127) were identified after matching according to sex, age, lesion size and number of lesions. The clinicopathological factors associated with survival were examined by univariate and multivariate analyses.
The mean duration of sorafenib treatment was 10.8 Â± 10.51 months (median 6.1(2.5-15.74). Addition of sorafenib significantly increased the median survival time of patients with unresectable HCC as well as recurrent disease (both p ≤ 0.013). The survival of patients with unresectable HCC was impacted by the presence of tumor thrombus in the portal vein (HR = 1.47, p = 0.004) and treatment (TACE + sorafenib, HR = 0.72, p = 0.003). For patients with recurrent HCC, the presence of extrahepatic metastasis (HR = 1.71, p = 0.012) and treatment (TACE + sorafenib, HR = 0.60, p = 0.002) also impacted survival. After adjusting for factors associated with survival in univariate analyses (e.g., tumor size ≥5 cm, tumor thrombus in the portal vein, extrahepatic metastasis, and duration of sorafenib treatment), the hazard of death in patients treated with TACE + sorafenib decreased with increased duration of sorafenib treatment (HR = 0.9, p < 0.001). For patients with recurrence receiving TACE + sorafenib, multivariate analysis also showed decreased hazard of death with longer duration of sorafenib treatment (HR = 0.9, p < 0.001).
TACE + sorafenib has survival benefit, particularly for HCC patients with disease recurrence. The addition of sorafenib to TACE at an earlier stage (i.e., prior to progression to PVTT or worsening AFP) may confer additional survival benefit. Further clinical studies are required to confirm these results and identify which patients are most likely to benefit from this therapeutic strategy.
Clinical trial identification
All authors have declared no conflicts of interest.