Sorafenib therapy following resection prolongs disease-free survival in patients with advanced hepatocellular carcinoma at a high risk of recurrence
Sorafenib therapy following resection prolongs disease-free survival in patients with advanced hepatocellular carcinoma at a high risk of recurrence
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切除后索拉非尼治疗可延长复发风险高的晚期肝细胞癌患者的无病生存期
DOI：
10.3892/ol.2016.5525
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发表时间：
2017-02-01
期刊：
影响因子：
2.9
通讯作者：
Yuan, Yunfei
中科院分区：
文献类型：
--
作者：
Liao, Yadi;Zheng, Yun;Yuan, Yunfei
索拉非尼是晚期肝细胞癌（HCC）患者的标准全身治疗方法;然而，其在HCC患者切除术后的治疗价值仍存在争议。目前的回顾性研究是为了评估索拉非尼治疗手术切除后的晚期肝癌患者谁是复发的高风险的影响。在2010年7月至2013年7月期间，42例晚期HCC和高复发风险（即，合并门静脉癌栓、邻近脏器受累或肿瘤破裂者）行手术切除。患者分为索拉非尼组（n=14）和最佳支持治疗（BSC）组（n=28）。尽管索拉非尼和BSC组之间的组织学分级、巴塞罗那临床肝癌分期、肿瘤大小、结节数量和具有高血清甲胎蛋白水平的患者比例相当，但切除后接受索拉非尼的患者具有显著更长的无病生存期（DFS），为5.2个月[95%置信区间（CI），1.2-9.2个月]与BSC组[1.8个月（95% CI，0.6-3.0个月）]相比。两组间的总生存率无差异。此外，没有药物相关不良事件导致索拉非尼治疗中止。单变量对数秩分析显示索拉非尼治疗（P=0.002）和切除前治疗（P=0.012）与DFS延长显著相关;然而，多变量分析显示索拉非尼治疗（P=0.027）和肿瘤大小（P=0.028）与DFS延长相关。此外，索拉非尼耐受性良好，并改善了接受肝切除术的晚期HCC患者的DFS。因此，肿瘤切除术后索拉非尼治疗可能是晚期HCC患者的有效治疗策略。这种可能性应该在更大的多中心研究中得到证实。
Sorafenib is the standard systemic treatment for patients with advanced hepatocellular carcinoma (HCC); however, its therapeutic value in patients with HCC following resection remains controversial. The current retrospective study was undertaken to assess the effects of sorafenib treatment following surgical resection in patients with advanced HCC disease who were at a high risk for recurrence. Between July 2010 and July 2013, a consecutive cohort of 42 patients with advanced HCC and at a high risk of recurrence (i.e., those with portal vein tumor thrombosis, adjacent organ involvement or tumor rupture) who underwent resection were analyzed. The patients were categorized into the sorafenib group (n=14) or the best supportive care (BSC) group (n=28). Although the histological grade, Barcelona Clinic Liver Cancer Stage, tumor size, nodule number and proportion of patients with high serum a-fetoprotein levels were comparable between the sorafenib and BSC groups, those receiving sorafenib following resection had significantly longer disease-free survival (DFS) of 5.2 months [95% confidence interval (CI), 1.2-9.2 months] compared with the BSC group [1.8 months (95% CI, 0.6-3.0 months)]. No differences in overall survival were noted between the groups. Furthermore, no drug-related adverse events resulted in discontinuation of sorafenib therapy. Univariate log-rank analysis revealed that sorafenib treatment (P=0.002) and treatment prior to resection (P=0.012) were significantly associated with longer DFS; however, sorafenib therapy (P=0.027) and tumor size (P=0.028) were associated with longer DFS by multivariate analysis. Furthermore, sorafenib was well-tolerated and improved DFS in patients with advanced HCC who underwent hepatic resection. Thus, tumor resection followed by sorafenib therapy may represent an effective therapeutic strategy for patients with advanced HCC. This possibility should be confirmed in larger, multicenter studies.