Comparison of radiofrequency ablation combined with sorafenib or sorafenib alone in patients with ECOG performance score 1: identifying optimal candidates

Lei Liu; Qian Zhang; Jie Geng; Songlun Li; Shoujie Zhao; Xiangnan Zhang; Jie Hu; Dayun Feng

doi:10.21037/atm.2020.03.71

Comparison of radiofrequency ablation combined with sorafenib or sorafenib alone in patients with ECOG performance score 1: identifying optimal candidates

Ann Transl Med. 2020 May;8(9):583. doi: 10.21037/atm.2020.03.71.

Authors

Lei Liu¹, Qian Zhang², Jie Geng³, Songlun Li⁴, Shoujie Zhao⁵, Xiangnan Zhang⁶, Jie Hu⁷, Dayun Feng⁸

Affiliations

¹ Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
² Division of Medical Affairs, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
³ Teaching and research section of Surgery, Tangdu Hospital, Xi'an 710038, China.
⁴ Department of Blood Transfusion, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁵ Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁶ Division of Scientific Research, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁷ Department of Clinical Laboratory, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁸ Department of Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.

Abstract

Background: Sorafenib has been recommended as the first-line treatment and shown to prolong the median overall survival (OS) of patients with advanced unresectable hepatocellular carcinoma (HCC). Recently, a growing number of earlier studies showed the application of radiofrequency ablation (RFA) plus sorafenib in patients diagnosed at the advanced-stage HCC. This study aimed to compare the outcomes of RFA plus sorafenib versus sorafenib alone and identify prognostic factors related to OS for BCLC stage C patients with PS 1 but without vascular invasion or extrahepatic spread.

Methods: A total of 276 consecutive patients in BCLC stage C with PS 1 but without vascular invasion or extrahepatic spread were enrolled in this retrospective study. Survival analyses were performed using the Kaplan-Meier analysis, and the log-rank test examined the statistical differences between the transarterial chemoembolization (TACE) and sorafenib groups. Univariate and multivariate Cox regression analyses were performed to investigate the prognostic factors for OS.

Results: Based on the Kaplan-Meier curves, patients treated with RFA plus sorafenib showed better OS than those undergoing sorafenib, with respective OS at 1, 3 and 5 years (84.0%, 43.1%, 22.8% vs. 55.6%, 29.6%, 4.8%, Log-rank P<0.001). The univariate analysis and multivariate analysis showed that tumor size, tumor number, treatment method, albumin, bilirubin, and the Child-Pugh score were associated with OS. According to the subgroups analyses based on the tumor size and tumor number, there were significant differences in OS among overall subsets except in patients with tumor number ≥4 between RFA plus sorafenib and sorafenib therapy.

Conclusions: RFA plus sorafenib provided better prognostic performance than sorafenib, which should be suggested as an alternative treatment modality compared with sorafenib for BCLC stage C patients with PS 1 but without vascular invasion or extrahepatic spread.

Keywords: Eastern Cooperative Oncology Group (ECOG); Radiofrequency ablation (RFA); hepatocellular carcinoma (HCC); sorafenib.