Lee Sangheun, Kang Jung Hyun, Kim Do Young, Ahn Sang Hoon, Park Jun Yong, Kim Beom Kyung, Kim Seung Up, Han Kwang-Hyub
Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
Institute for Integrative Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
Hepatol Int. 2017 May;11(3):292-299. doi: 10.1007/s12072-017-9792-3. Epub 2017 Mar 21.
There is no approved therapy for patients with failed transarterial chemoembolization (TACE) and progression of hepatocellular carcinoma. We aimed to investigate the efficacy and prognostic factors in patients with TACE failure who received sorafenib rescue therapy.
We investigated 54 patients who met the criteria of TACE failure as defined by the international guidelines of Europe and Japan. Sorafenib was used as a rescue therapy. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier methods, and multivariate analysis was performed to find prognostic factors.
The patients were followed for a median 5.5 months, and the median duration of sorafenib administration was 3.3 months. The presence of main (or lobar) portal vein invasion (PVI) (3.7 versus 8.4 months, p = 0.004), dose reduction of sorafenib (4.0 versus 8.8 months, p = 0.002) and Child-Pugh class B (5.3 versus 8.9 months, p = 0.004) were associated with shorter OS compared to the presence of segmental PVI (or absence of macroscopic vascular invasion, MVI), full dosage of sorafenib and Child-Pugh class A, respectively. The presence of main (or lobar) PVI was associated with poorer PFS compared to the presence of segmental PVI (or absence of MVI) (2.1 versus 3.8 months p = 0.010).
Sorafenib is a potential rescue therapy in patients with TACE failure. However, the clinical benefits need to be further evaluated for patients with main (or lobar) PVI or those treated with reduced doses of sorafenib.
对于经动脉化疗栓塞术（TACE）失败且肝细胞癌进展的患者，尚无获批的治疗方法。我们旨在研究接受索拉非尼挽救治疗的TACE失败患者的疗效和预后因素。
我们调查了54例符合欧洲和日本国际指南所定义的TACE失败标准的患者。使用索拉非尼作为挽救治疗。采用Kaplan-Meier方法分析总生存期（OS）和无进展生存期（PFS），并进行多因素分析以寻找预后因素。
患者的中位随访时间为5.5个月，索拉非尼的中位给药持续时间为3.3个月。与存在节段性门静脉侵犯（或无宏观血管侵犯，MVI）、索拉非尼全剂量和Child-Pugh A级相比，存在主要（或叶）门静脉侵犯（PVI）（3.7个月对8.4个月，p = 0.004）、索拉非尼剂量减少（4.0个月对8.8个月，p = 0.002）和Child-Pugh B级（5.3个月对8.9个月，p = 0.004）与较短的OS相关。与存在节段性PVI（或无MVI）相比，存在主要（或叶）PVI与较差的PFS相关（2.1个月对3.8个月，p = 0.010）。
索拉非尼是TACE失败患者的一种潜在挽救治疗方法。然而，对于存在主要（或叶）PVI或接受索拉非尼减量治疗的患者，其临床益处需要进一步评估。
