Sarpel Umut, Spivack John H, Berger Yaniv, Heskel Marina, Aycart Samantha N, Sweeney Robert, Edwards Martin P, Labow Daniel M, Kim Edward
Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
HPB (Oxford). 2016 May;18(5):411-8. doi: 10.1016/j.hpb.2016.02.007. Epub 2016 Mar 17.
BACKGROUND & AIMS: It is unknown whether the addition of locoregional therapies (LRTx) to sorafenib improves prognosis over sorafenib alone in patients with advanced hepatocellular carcinoma (HCC). The aim of this study was to assess the effect of LRTx in this population.
A retrospective analysis was performed of patients with advanced HCC as defined by extrahepatic metastasis, lymphadenopathy >2 cm, or gross vascular invasion. Sorafenib therapy was required for inclusion. Survival of patients who received LRTx after progression to advanced stage was compared to those who did not receive LRTx.
Using an intention to treat analysis of 312 eligible patients, a propensity weighted proportional hazards model demonstrated LRTx as a predictor of survival (HR = 0.505, 95% CI: 0.407-0.628; P < 0.001). The greatest benefit was seen in patients with the largest tumor burden (HR = 0.305, 95% CI: 0.236-0.393; P < 0.01). Median survival in the sorafenib arm was 143 days (95% CI: 118-161) vs. 247 days (95% CI: 220-289) in the sorafenib plus LRTx arm (P < 0.001).
These results demonstrate a survival benefit with the addition of LRTx to sorafenib for patients with advanced HCC. These findings should prompt a prospective clinical trial to further assess the role of LRTx in patients with advanced HCC.
对于晚期肝细胞癌（HCC）患者，在索拉非尼基础上加用局部区域治疗（LRTx）是否比单纯使用索拉非尼能改善预后尚不清楚。本研究的目的是评估LRTx对这一人群的疗效。
对符合以下条件的晚期HCC患者进行回顾性分析：存在肝外转移、淋巴结肿大>2 cm或肉眼可见血管侵犯。纳入患者均需接受索拉非尼治疗。将进展至晚期后接受LRTx的患者生存率与未接受LRTx的患者进行比较。
采用意向性分析纳入312例符合条件的患者，倾向加权比例风险模型显示LRTx是生存的预测因素（风险比[HR]=0.505，95%置信区间[CI]：0.407 - 0.628；P<0.001）。在肿瘤负荷最大的患者中观察到最大获益（HR=0.305，95%CI：0.236 - 0.393；P<0.01）。索拉非尼组的中位生存期为143天（95%CI：118 - 161），而索拉非尼加LRTx组为247天（95%CI：220 - 289）（P<0.001）。
这些结果表明，对于晚期HCC患者，在索拉非尼基础上加用LRTx可带来生存获益。这些发现应促使开展一项前瞻性临床试验，以进一步评估LRTx在晚期HCC患者中的作用。
