Chemotherapy combined with radiotherapy can benefit more unresectable HCC patients with portal and/or hepatic vein invasion: a retrospective analysis of the SEER database

Xiaotong Qiu; Jianye Cai; Haitian Chen; Jia Yao; Cuicui Xiao; Rong Li; Jiaqi Xiao; Jiebin Zhang; Xin Sui; Tongyu Lu; Jun Zheng; Yingcai Zhang; Yang Yang

doi:10.3389/fonc.2023.1098686

Chemotherapy combined with radiotherapy can benefit more unresectable HCC patients with portal and/or hepatic vein invasion: a retrospective analysis of the SEER database

Front Oncol. 2023 Jun 20:13:1098686. doi: 10.3389/fonc.2023.1098686. eCollection 2023.

Authors

Xiaotong Qiu^{1

2}, Jianye Cai^{1

2}, Haitian Chen^{1

2}, Jia Yao^{1

2}, Cuicui Xiao^{2

3}, Rong Li^{1

2}, Jiaqi Xiao^{1

2}, Jiebin Zhang^{1

2}, Xin Sui^{2

4}, Tongyu Lu^{1

2}, Jun Zheng^{1

2}, Yingcai Zhang^{1

2}, Yang Yang^{1

2}

Affiliations

¹ Department of Hepatic Surgery and Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Guangdong Province Key Laboratory of Liver Disease Research, Guangzhou, China.
³ Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁴ Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

Background: The purpose of this study is to evaluate the effects of chemotherapy and radiotherapy on the prognosis of unresectable HCC patients with portal and/or hepatic vein invasion.

Methods: A retrospective analysis of unresectable HCC patients with portal and/or hepatic vein invasion registered in the Surveillance, Epidemiology, End Results (SEER) database was performed. The propensity score-matching (PSM) method was used to balance differences between groups. Overall survival (OS) and cancer-specific survival (CSS) were the interesting endpoints. OS was calculated from the date of diagnosis to the date of death caused by any cause or the last follow-up. CSS was defined as the interval between the date of diagnosis and date of death due only to HCC or last follow-up. OS and CSS were analyzed by using Kaplan-Meier analysis, Cox proportional hazards model, and Fine-Gray competing-risk model.

Results: A total of 2,614 patients were included. 50.2% patients received chemotherapy or radiotherapy and 7.5% patients received both chemotherapy and radiotherapy. Compared to the untreated group, chemotherapy or radiotherapy (COR) (HR = 0.538, 95% CI 0.495-0.585, p < 0.001) and chemotherapy and radiotherapy (CAR) (HR = 0.371, 95% CI 0.316-0.436, p < 0.001) showed better OS. In the COR group, Cox analysis results showed AFP, tumor size, N stage and M stage were independent risk factor of OS. Competing-risk analysis results showed AFP, tumor size and M stage were independent risk factor of CSS. In the CAR group, AFP and M stage were independent risk factors of OS. Competing-risk analysis results showed M stage were independent risk factor of CSS. Kaplan Meier analysis showed chemotherapy combined with radiotherapy significantly improves OS (10.0 vs. 5.0 months, p < 0.001) and CSS (10.0 vs. 6.0 months, p = 0.006) than monotherapy.

Conclusion: AFP positive and distant metastasis are the main risk factors affecting OS and CSS of unresectable HCC patients with portal and/or hepatic vein invasion. Chemotherapy combined with radiotherapy significantly improves OS and CSS of unresectable HCC patients with portal and/or hepatic vein invasion.

Keywords: chemotherapy; end results database; epidemiology; hepatocellular carcinoma; prognosis; radiotherapy; surveillance.

Grants and funding

This study was supported by the National Natural Science Foundation of China. (Grant/AwardNumber:81900597); Natural Science Foundation of Guangdong Province, China. (Grant/AwardNumber:2021A1515012136); National Natural Science Foundation of China. (Grant/AwardNumber:81802897); Natural Science Foundation of Guangdong Province, China. (Grant/AwardNumber:2021A1515011156); National Natural Science Foundation of China. (Grant/AwardNumber:82100693); National Natural Science Foundation of China. (Grant/AwardNumber:81901943); National Natural Science Foundation of China. (Grant/AwardNumber:81770648); National Natural Science Foundation of China. (Grant/AwardNumber:81970567); Natural Science Foundation of Guangdong Province, China. (Grant/AwardNumber:2021A1515010571); Natural Science Foundation of Guangdong Province, China. (Grant/AwardNumber:2018A030313043).