Lokesh K N, Chaudhuri Tamojit, Lakshmaiah K C, Babu K Govind, Dasappa Lokanatha, Jacob Linu Abraham, Suresh Babu M C, Rudresha A H, Rajeev L K
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
Indian J Cancer. 2017 Jul-Sep;54(3):526-529. doi: 10.4103/ijc.IJC_373_17.
Hepatocellular carcinoma (HCC) is a major health burden and the seventh most common cause of cancer-related death in India. Patients with advanced unresectable HCC have a poor prognosis with a reported median survival of only 2-3 months with the best supportive care (BSC). Sorafenib is the only drug that has demonstrated a survival benefit over BSC in advanced HCC. Unfortunately, even though it has been used for a long time, there are very few published data regarding the experience of sorafenib therapy in advanced HCC from India.
Patients diagnosed with advanced HCC from January 2012 to July 2017 at our center were reviewed retrospectively. Patients' profile, time to progression, survival, and toxicity of sorafenib therapy were evaluated.
Of the 48 advanced patients with HCC, 35 (72.9%) were male. The median age at diagnosis was 52 years. The most common presenting symptom was abdominal pain (77%, n = 37), followed by abdominal distension (37.5%, n = 18), loss of appetite and/or weight (33.3%, n = 16), and jaundice (16.7%, n = 8). Hepatitis B virus infection was documented in 37 patients (77%), whereas 4 patients had hepatitis C virus infection. Patients were treated with standard dose sorafenib (n = 30), BSC alone (n = 14), or transarterial chemoembolization followed by sorafenib (n = 4). Sorafenib therapy was well-tolerated in most cases. The median progression-free survival with upfront sorafenib was 4.3 months. The median overall survival (OS) of the patients who received upfront sorafenib was significantly better than those treated with BSC alone (5.9 vs 3.0 months; log-rank P= 0.00).
Sorafenib therapy was well-tolerated and provided about 3 months longer median OS in our patients with advanced HCC than those treated with BSC alone.
肝细胞癌（HCC）是一项重大的健康负担，在印度是癌症相关死亡的第七大常见原因。晚期不可切除HCC患者预后较差，据报道，在最佳支持治疗（BSC）下，中位生存期仅为2 - 3个月。索拉非尼是唯一一种在晚期HCC中显示出比BSC更具生存获益的药物。不幸的是，尽管它已被使用很长时间，但关于印度晚期HCC患者索拉非尼治疗经验的已发表数据却非常少。
对2012年1月至2017年7月在我们中心诊断为晚期HCC的患者进行回顾性研究。评估患者的资料、疾病进展时间、生存率以及索拉非尼治疗的毒性。
48例晚期HCC患者中，35例（72.9%）为男性。诊断时的中位年龄为52岁。最常见的症状是腹痛（77%，n = 37），其次是腹胀（37.5%，n = 18）、食欲不振和/或体重减轻（33.3%，n = 16）以及黄疸（16.7%，n = 8）。37例患者（77%）有乙肝病毒感染记录，而4例患者有丙肝病毒感染。患者接受标准剂量索拉非尼治疗（n = 30）、单纯BSC治疗（n = 14）或经动脉化疗栓塞后再用索拉非尼治疗（n = 4）。在大多数情况下，索拉非尼治疗耐受性良好。一线使用索拉非尼的中位无进展生存期为4.3个月。接受一线索拉非尼治疗的患者的中位总生存期（OS）明显优于单纯接受BSC治疗的患者（5.9个月对3.0个月；对数秩检验P = 0.00）。
索拉非尼治疗耐受性良好，与单纯接受BSC治疗的晚期HCC患者相比，我们的患者接受索拉非尼治疗后的中位OS延长了约3个月。
