J Hepatocell Carcinoma. 2021;8:587-598.

Effectiveness of Transarterial Chemoembolization-First Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis.

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제1저자 정성원, 박민경, 조영윤 · 교신저자 이정훈

PMID 34164351 PMC8214527 DOI 10.2147/JHC.S294440 IF 3.9 소화기내과

소속 (3)

Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND Still in real-world practice, advanced hepatocellular carcinoma (HCC) patients are treated with transarterial chemoembolization (TACE). This study compared the therapeutic effectiveness of initial TACE treatment and initial sorafenib treatment in advanced HCC patients.

PATIENT AND METHODS Advanced HCC patients initially treated with sorafenib or TACE were included in this study. Treatment crossover due to an unfavorable response to initial treatment was allowed. Propensity score (PS) matching was applied for balancing baseline characteristics. The primary outcome was overall survival (OS) and the secondary outcomes included tumor response.

RESULTS A total of 554 patients were included in this study: 85 were initially treated with sorafenib (the sorafenib-first group) and 469 with TACE (the TACE-first group). In the entire cohort, the TACE-first group was associated with lower risk of death [adjusted hazard ratio (HR)=0.75, P=0.04]. In the PS-matched cohort (85 patients per group), the TACE-first group showed longer OS than the sorafenib-first group in both univariable (HR=0.68, P=0.02) and multivariable analyses (adjusted HR=0.58, P=0.002). Specifically, within both the entire and the PS-matched cohorts, the TACE-first group showed longer OS in subgroups with major portal vein tumor thrombosis (HR=0.72, P=0.048; HR=0.52, P=0.003) or infiltrative HCC (HR=0.42, P<0.001; HR=0.30, P=0.004, respectively). The objective response rate was higher in the TACE-first group (29.3% vs 14.7%, P=0.03) within the PS-matched cohort.

CONCLUSION For advanced HCC, initial TACE leads to longer OS with a more favorable tumor response than initial sorafenib treatment. Intrahepatic tumor control with initial locoregional therapy may be a potent strategy for advanced HCC.

Keywords

liver cancerlocoregional therapytransarterial therapytyrosine kinase inhibitor

Figures

**Figure 1** Cumulative incidence of primary outcomes (PS-matched cohort). (A) Overall survival. (B) Time to progression. Survival curves were compared using the Log rank test. Time to progression was evaluated only in patients with follow-up images.

**Figure 2** Cumulative incidence of overall survival and time to progression in patients with different responses (PS-matched cohort). (A) Overall survival among patients with objective response (complete or partial response). (B) Time to progression among patients with objective response (complete or partial response). (C) Overall survival among patients without objective response (stable disease or progressive disease). (D) Time to progression among patients without objective response (stable disease or progressive disease). Tumor response was defined in accordance with best overall response. Time to progression was evaluated only in patients with follow-up images. Survival curves were compared using the Log rank test. Time to progression was evaluated only in patients with follow-up images.

**Figure 3** Forest plots of overall survival in patient subgroups. (A) Subgroup analysis of the entire cohort. (B) Subgroup analysis of the PS-matched cohort. Horizontal lines represent 95% confidence intervals. Confidence intervals and hazard ratios were computed using the Cox proportional hazard model. ^‡Treatment crossover patients were defined as patients who changed their treatment (TACE to sorafenib or *vice versa*) throughout the follow-up period. PVTT was classified in accordance with the classification system of the Liver Cancer Study Group of Japan. *Minor PVTT was defined as tumor involvement distal to, but not in, the second-order branches of the portal vein (Vp1) or the second-order branches of the portal vein (Vp2). ^†Major PVTT was defined as tumor involvement of the right or left portal vein (Vp3) or the main portal vein (Vp4).

그림 출처: PubMed Central 공개 논문 (PMC8214527)

Conflict of interest statement

Dr. Lee YB reports receiving research grant from Samjin Pharmaceuticals; Dr. Yu SJ reports lecture fee from Bayer HealthCare Pharmaceuticals; Dr. Kim YJ reports receiving research grants from Bristol-Myers Squibb, Roche, JW Creagene, Bukwang Pharmaceuticals, Handok Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals, Samjin Pharmaceuticals, AstraZeneca, and Pharmaking, and lecture fees from Bayer HealthCare Pharmaceuticals, Gilead Science, MSD Korea, Yuhan Pharmaceuticals, Samil Pharmaceuticals, CJ Pharmaceuticals, Bukwang Pharmaceuticals, and Handok Pharmaceuticals; Dr. Chung JW reports receiving educational grant from Guerbet; Dr. Yoon JH reports receiving research grants from AstraZeneca, Bayer HealthCare Pharmaceuticals, Daewoong Pharmaceuticals, and Bukwang Pharmaceuticals; Dr. Lee JH reports receiving lecture fee from GreenCross Cell, Daewoong Pharmaceuticals, and Gilead Korea. No other potential conflicts of interest relevant to this article were reported.

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