Kok Victor C, Chen Yu-Ching, Chen Yang-Yuan, Su Yu-Chieh, Ku Ming-Chang, Kuo Jung-Tsung, Yoshida Go J
Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung 43303, Taiwan.
Disease Informatics Research Group, Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung 41354, Taiwan.
Cancers (Basel). 2019 Jul 15;11(7):985. doi: 10.3390/cancers11070985.
We hypothesized that sorafenib plus transarterial chemoembolization (TACE) would confer survival benefits over sorafenib alone for advanced hepatocellular carcinoma (aHCC). We investigated this while using the population-based All-Cancer Dataset to assemble a cohort ( = 3674; median age, 60; 83% men) of patients receiving sorafenib for aHCC (Child-Pugh A) with macro-vascular invasion or nodal/distant metastases. The patients were classified into the sorafenib-TACE group ( = 426) or the propensity score-matched sorafenib-alone group ( = 1686). All of the participants were followed up until death or the end of the study. Time-dependent Cox model and the Mantel-Byar test were used for survival analysis. During the median follow-ups of 221 and 133 days for the sorafenib-TACE and sorafenib-alone groups, 164 (39%) and 916 (54%) deaths occurred, respectively; the corresponding median overall survivals (OS) were 381 and 204 days, respectively (hazard ratio, HR: 0.74; 95% confidence interval, CI, 0.63-0.88; = 0.021). The one-year and six-month OS were 53.5% and 80.3% in the sorafenib-TACE group and 32.4% and 54.4% in the sorafenib-alone group, respectively. The major complications were comparable between the two groups. The addition of TACE to sorafenib improves survival, with a 26% reduction in mortality. These findings provide strong real-world evidence that supports this combination strategy for eligible Child-Pugh A aHCC patients.
我们假设，对于晚期肝细胞癌（aHCC），索拉非尼联合经动脉化疗栓塞术（TACE）比单纯使用索拉非尼更能带来生存获益。我们利用基于人群的全癌数据集，纳入了一组接受索拉非尼治疗的aHCC（Child-Pugh A级）伴大血管侵犯或淋巴结/远处转移的患者（n = 3674；中位年龄60岁；83%为男性），对这一假设进行了研究。患者被分为索拉非尼-TACE组（n = 426）或倾向评分匹配的单纯索拉非尼组（n = 1686）。所有参与者均随访至死亡或研究结束。采用时间依赖性Cox模型和Mantel-Byar检验进行生存分析。在索拉非尼-TACE组和单纯索拉非尼组分别进行的中位随访221天和133天期间，分别有164例（39%）和916例（54%）患者死亡；相应的中位总生存期（OS）分别为381天和204天（风险比，HR：0.74；95%置信区间，CI，0.63 - 0.88；P = 0.021）。索拉非尼-TACE组的1年和6个月总生存率分别为分别为53.5%和80.3%，单纯索拉非尼组分别为32.4%和54.4%。两组的主要并发症相当。索拉非尼联合TACE可提高生存率，死亡率降低26%。这些发现提供了有力的真实世界证据，支持 eligible Child-Pugh A级aHCC患者采用这种联合治疗策略。
