Li Jiang, Hou Yu, Cai Xiao-Bei, Liu Bin
Jiang Li, Xiao-Bei Cai, Bin Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China.
World J Gastroenterol. 2016 Apr 21;22(15):4034-40. doi: 10.3748/wjg.v22.i15.4034.
To evaluate whether sorafenib use after resection impacts tumor relapse and survival in Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC).
This retrospective study enrolled 36 male BCLC stage C HCC patients with portal vein thrombus and Child-Pugh class A liver function. Twenty-four patients received only surgical resection (SR), and 12 patients received oral sorafenib within 30 d after surgery. The primary outcomes were time to progression (TTP) (the time from surgical resection until HCC recurrence or extrahepatic metastases) and overall survival (OS). The secondary outcome was the rate of postoperative recurrence or metastasis. TTP and OS were analyzed using Kaplan Meier curves.
There were no significant differences between the two groups in the serum levels of alpha-fetoprotein, copies of hepatitis B virus-DNA, preoperative laboratory results, degree of hepatic fibrosis, types of portal vein tumor thrombus, number of satellite lesions, tumor diameter, pathological results, volume of blood loss, volume of blood transfusion, or surgery time (all P > 0.05). Patients in the SR + sorafenib group had a significantly longer TTP (29 mo vs 22 mo, P = 0.041) and a significantly longer median OS (37 mo vs 30 mo, P = 0.01) compared to patients in the SR group. The SR group had 18 cases (75%) of recurrence/metastasis while the SR + sorafenib group had six cases (50%) of recurrence/metastasis. A total of 19 patients died after surgery (five in the SR + sorafenib group and 14 in the SR group). The most common sorafenib-related adverse events were skin reactions, diarrhea, and hypertension, all of which were resolved with treatment.
Sorafenib after SR was well-tolerated. Patients who received sorafenib after SR had better outcomes compared to patients who received only SR.
评估在巴塞罗那临床肝癌（BCLC）C期肝细胞癌（HCC）切除术后使用索拉非尼是否会影响肿瘤复发和生存。
本回顾性研究纳入了36例男性BCLC C期伴有门静脉血栓且肝功能为Child-Pugh A级的HCC患者。24例患者仅接受手术切除（SR），12例患者在术后30天内接受口服索拉非尼治疗。主要结局为疾病进展时间（TTP）（从手术切除至HCC复发或肝外转移的时间）和总生存期（OS）。次要结局为术后复发或转移率。采用Kaplan-Meier曲线分析TTP和OS。
两组在甲胎蛋白血清水平、乙肝病毒DNA拷贝数、术前实验室检查结果、肝纤维化程度、门静脉肿瘤血栓类型、卫星灶数量、肿瘤直径、病理结果、失血量、输血量或手术时间方面均无显著差异（均P>0.05）。与SR组患者相比，SR+索拉非尼组患者的TTP显著更长（29个月对22个月，P=0.041），中位OS也显著更长（37个月对30个月，P=0.01）。SR组有18例（75%）复发/转移，而SR+索拉非尼组有6例（50%）复发/转移。共有19例患者术后死亡（SR+索拉非尼组5例，SR组14例）。最常见的索拉非尼相关不良事件为皮肤反应、腹泻和高血压，所有这些经治疗后均得到缓解。
SR后使用索拉非尼耐受性良好。与仅接受SR的患者相比，SR后接受索拉非尼的患者结局更好。
