Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shibin El-Kom, 32511, Egypt.
Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia University, Menoufia, Shibin El Kom City, 32511, Egypt.
BMC Cancer. 2024 Nov 28;24(1):1466. doi: 10.1186/s12885-024-13199-1.
Switching to systemic therapy after transarterial chemoembolization (TACE) refractoriness is more inclined to preserve liver function and decrease disease progression. Hence, we conducted a comparison between the advantages of sorafenib therapy and the continuation of TACE in patients with intermediate-stage hepatocellular carcinoma (HCC) who developed TACE refractoriness.
This retrospective cohort work involved 1,200 patients with HCC who received TACE therapy at our institution between January 2018 and December 2022. Out of these, a total of 436 participants were determined to be resistant to TACE treatment throughout their clinical progression. Out of them, 271 were finally included and categorized into two groups: (1) patients who shifted from TACE to sorafenib, and (2) patients who maintained TACE treatment. The study assessed the overall survival (OS) and time to disease progression (TTDP) of patients who were resistant to TACE, comparing both groups based on when they achieved Child-Pugh C or acquired advanced-stage HCC.
Following confirmation of refractoriness to TACE therapy, 163 opted to continue with TACE (TACE group), whereas 108 shifted to sorafenib treatment (sorafenib group). The median TTDP was 23.36 months, while the median OS was 25.3 months, in the sorafenib group, and 11.6 and 14.2 months, correspondingly, in the TACE group (p = 0.0001).
Switching to sorafenib treatment significantly improved OS and TTDP in patients with intermediate-stage HCC who were refractory to TACE. These finding highlights sorafenib's potential as an effective alternative for managing disease progression in patients unresponsive to TACE, offering a valuable treatment option in this challenging clinical scenario.
经肝动脉化疗栓塞（TACE）治疗后出现耐药的患者，更倾向于接受系统治疗以保留肝功能并延缓疾病进展。因此，我们对 TACE 耐药的中期肝细胞癌（HCC）患者中索拉非尼治疗的优势与继续 TACE 治疗进行了比较。
本回顾性队列研究纳入了 2018 年 1 月至 2022 年 12 月在我院接受 TACE 治疗的 1200 例 HCC 患者，其中 436 例患者在整个临床过程中被确定为 TACE 耐药。最终纳入 271 例患者，并分为两组：（1）从 TACE 转为索拉非尼治疗的患者，（2）继续 TACE 治疗的患者。该研究评估了 TACE 耐药患者的总生存（OS）和疾病进展时间（TTDP），并根据患者达到 Child-Pugh C 或进展为晚期 HCC 的时间，比较了两组患者的 OS 和 TTDP。
在确认对 TACE 治疗耐药后，163 例患者继续接受 TACE（TACE 组）治疗，108 例患者转为索拉非尼治疗（索拉非尼组）。索拉非尼组的中位 TTDP 为 23.36 个月，中位 OS 为 25.3 个月，TACE 组分别为 11.6 个月和 14.2 个月（p=0.0001）。
对于 TACE 耐药的中期 HCC 患者，转为索拉非尼治疗显著改善了 OS 和 TTDP。这些发现突显了索拉非尼在 TACE 无反应患者中作为疾病进展管理的有效替代方案的潜力，为这一具有挑战性的临床情况提供了有价值的治疗选择。
