Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
PLoS One. 2019 Mar 7;14(3):e0213547. doi: 10.1371/journal.pone.0213547. eCollection 2019.
Currently, sorafenib is indicated for hepatocellular carcinoma (HCC) with extrahepatic metastasis (EHM), and many other systemic agents are becoming available. However, a few HCC patients with EHM still undergo transarterial chemoembolization (TACE) for intrahepatic tumor control. We aimed to investigate whether TACE is appropriate for patients with EHM, and if so, which subgroup may benefit from TACE.
A total of 186 consecutive HCC patients (median: 55 years, male: 86.0%, hepatitis B virus: 81.7%, Child-Pugh Class A: 83.3%) with EHM (nodal metastasis: 60.8%, distant metastasis: 39.2%) between 2010 and 2014 were analyzed. Initial treatment included sorafenib in 69 patients, and TACE in 117 patients.
During a median follow-up of 6.6 months (range: 0.2-94.6 months), mortality was observed in 90.3% (168/186). The median survival was better for patients who received TACE than those treated with sorafenib (8.2 months vs. 4.6 months, p < 0.001). However, baseline characteristics varied between patients initially treated with TACE and sorafenib, and the treatment modality was not an independent factor associated with overall survival (hazard ratio: 1.19, 95% confidence interval: 0.81-1.75, p = 0.36). In sub-group analysis, TACE was associated with better survival only among younger patients and those with segmental/lobar portal vein invasion.
In HCC patients with EHM, TACE was not an independent favorable prognostic factor compared to sorafenib. The concept of intrahepatic control in HCC patients with EHM may need to be reevaluated in the era of promising systemic therapies, although there can be specific subgroups who still benefit from TACE.
目前，索拉非尼适用于伴肝外转移（EHM）的肝细胞癌（HCC），并且有许多其他系统药物可供使用。然而，仍有少数伴 EHM 的 HCC 患者接受经动脉化疗栓塞（TACE）以控制肝内肿瘤。我们旨在研究 TACE 是否适用于伴 EHM 的患者，如果适用，哪些亚组可能从 TACE 中获益。
回顾性分析了 2010 年至 2014 年间 186 例连续的伴 EHM（淋巴结转移：60.8%，远处转移：39.2%）的 HCC 患者（中位年龄：55 岁，男性：86.0%，乙型肝炎病毒：81.7%，Child-Pugh 分级 A：83.3%）。初始治疗包括索拉非尼 69 例，TACE 117 例。
在中位随访 6.6 个月（范围：0.2-94.6 个月）期间，186 例患者中有 90.3%（168/186）死亡。与接受索拉非尼治疗的患者相比，接受 TACE 治疗的患者中位生存期更好（8.2 个月 vs. 4.6 个月，p < 0.001）。然而，最初接受 TACE 和索拉非尼治疗的患者基线特征不同，且治疗方式不是总生存期的独立相关因素（风险比：1.19，95%置信区间：0.81-1.75，p = 0.36）。亚组分析显示，仅在年轻患者和存在节段性/叶性门静脉侵犯的患者中，TACE 与生存改善相关。
与索拉非尼相比，在伴 EHM 的 HCC 患者中，TACE 不是独立的有利预后因素。在有前途的系统治疗时代，可能需要重新评估伴 EHM 的 HCC 患者的肝内控制概念，尽管仍有特定的亚组可能从 TACE 中获益。
