A comparison of survival in patients with hepatocellular carcinoma and portal vein invasion treated by radioembolization or sorafenib

Liver Int. 2016 Aug;36(8):1206-12. doi: 10.1111/liv.13098. Epub 2016 Mar 23.

Abstract

Background & aims: Sorafenib (SOR) is the standard of care for patients with hepatocellular carcinoma (HCC) and portal vein invasion (PVI), based on the results of phase 3 trials. However, radioembolization (RE) using yttrium-90 microspheres has been shown to achieve higher response rates and better survival in large cohorts and phase 2 trials. This study aimed to compare survival of HCC patients with PVI treated by RE or SOR.

Methods: Survival among patients with HCC and PVI treated with RE or SOR in four Spanish hospitals between 2005 and 2013 was analysed retrospectively. Kaplan-Meier survival curves were plotted and baseline variables tested for prognostic value using the log-rank test. A multivariate prognostic model including variables identified in the univariate analysis and adjusted by a propensity score based on factors that may determine the probability of exposure to RE was generated using Cox regression analyses.

Results: After a median follow-up of 6 months, 60 deaths had occurred: 38 and 22 in SOR and RE groups respectively. Median survival was 6.7 months (95%CI 5.2-8.1 months) for the entire cohort, and 8.8 months (95%CI 1.8-15.8) in the RE group and 5.4 months (95%CI 2.7-8.1) in the SOR group (P = 0.047). The difference in survival was still statistically significant when 13 patients in the RE group who started SOR after a median time of 8 months were censored from the analysis.

Conclusions: In a cohort of patients with HCC and PVI treatment with RE was associated with a more prolonged survival compared with SOR.

Keywords: hepatocellular carcinoma; portal vein invasion; radioembolization; selective internal radiation therapy; sorafenib.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Hepatocellular / mortality*
  • Carcinoma, Hepatocellular / therapy*
  • Chemoembolization, Therapeutic*
  • Female
  • Humans
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / therapy*
  • Logistic Models
  • Male
  • Microspheres
  • Middle Aged
  • Niacinamide / analogs & derivatives*
  • Niacinamide / therapeutic use
  • Phenylurea Compounds / therapeutic use*
  • Portal Vein / pathology
  • Propensity Score
  • Radiopharmaceuticals / therapeutic use
  • Retrospective Studies
  • Sorafenib
  • Spain
  • Survival Analysis
  • Yttrium Radioisotopes / therapeutic use

Substances

  • Antineoplastic Agents
  • Phenylurea Compounds
  • Radiopharmaceuticals
  • Yttrium Radioisotopes
  • Niacinamide
  • Sorafenib