Sorafenib vs surgical resection for hepatocellular carcinoma with macrovascular invasion: A propensity score analysis

• Published in: Liver international 2017-12, Vol.37 (12), p.1869-1876
• Main Authors: Costentin, Charlotte E., Decaens, Thomas, Laurent, Alexis, Nault, Jean‐Charles, Paule, Bernard, Letoublon, Christian, Luciani, Alain, Calderaro, Julien, Adam, René, Bricault, Ivan, Amaddeo, Giuliana, Cherqui, Daniel, Mallat, Ariane, Samuel, Didier, Duvoux, Christophe, Ganne‐Carrié, Nathalie, Roudot‐Thoraval, Françoise, Vibert, Eric
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents - therapeutic use; Bilirubin; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Female; France - epidemiology; Hepatocellular carcinoma; Humans; Life Sciences; Liver - pathology; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; macrovascular invasion; Male; Middle Aged; Mortality; Multivariate analysis; Niacinamide - analogs & derivatives; Niacinamide - therapeutic use; Patients; Phenylurea Compounds - therapeutic use; propensity analysis; Propensity Score; Quality of life; Retrospective Studies; sorafenib; Surgery; surgical resection; Survival; Tumors
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13491

Background & Aim Sorafenib is the standard of care for patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI), with limited survival. Retrospective surgical studies have reported prolonged survival in this situation. This study aimed to compare the overall survival of patients with HCC and MVI treated with surgical resection or sorafenib. Methods A total of 143 patients with HCC and MVI but no extra‐hepatic spread, treated with surgical resection (SR‐patients; n=75) or sorafenib (SOR‐patients; n=68) in four French centres between 1990 and 2013 were reviewed retrospectively. A propensity score analysis was performed to reduce bias. Results SR‐patients were significantly younger and had a lower tumour burden than SOR‐patients. Median overall survival (OS) rates were 10.1 months [95% CI: 4.1‐16.1] in SR‐patients and 12.9 months [95% CI: 7.9‐17.9] in SOR‐patients (P=.959). The 90‐day mortality rate was 16% (n=12) in SR‐patients and 7.5% (n=5) in SOR‐patients (P=.196). SR‐patients had a median disease‐free survival of 4.60 months [95% CI: 3.3‐5.9]. Under the propensity analysis, median OS was 12.0 months [95% CI: 5.5‐18.5] in SR‐patients vs 9.7 months [95% CI: 6.1‐13.3] in SOR‐patients (P=.682). Under multivariate analysis, extensive MVI (HR=1.956, P=.024) and bilirubin >17 μmol/L (HR=1.738, P=.011) were the two factors significantly associated with mortality. Conclusion Under a propensity score analysis, the overall survival of patients with HCC and MVI undergoing surgical resection was similar to that achieved with sorafenib. We were not able to identify a patient subgroup experiencing a surgery‐related improvement in survival, and quality of life was not evaluable.