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Liver Int. 2017 Dec;37(12):1869-1876. doi: 10.1111/liv.13491. Epub 2017 Jul 13.

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

Author information

1
Unité d'hépatologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France.
2
Institute for Advanced Biosciences - Inserm U1209/CNRS UMR 5309/Université de Grenoble-Alpes, Grenoble, France.
3
Université Grenoble Alpes, Grenoble, France.
4
Clinique Universitaire d'Hépato-gastroentérologie, Pôle Digidune, CHU Grenoble, Grenoble, France.
5
Service de Chirurgie Digestive et Hépatobiliaire, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France.
6
INSERM U955, Team 18, Institut Mondor de Recherche Biomédicale, Créteil, France.
7
Université Paris-Est Créteil, Créteil, France.
8
Unité d'hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.
9
Unité Mixte de Recherche 1162, Génomique fonctionnelle des tumeurs solides, Institut National de la Santé et de la Recherche Médicale, Paris, France.
10
Centre Hepato Biliaire, Assistance Publique Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France.
11
Service de Chirurgie Digestive, CHU Grenoble, Grenoble, France.
12
Service d'Imagerie Médicale, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France.
13
Département de Pathologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France.
14
INSERM U776, Hopital Paul Brousse, Villejuif, France.
15
Service de radiologie, CHU Grenoble, Grenoble, France.
16
INSERM U1193, Hopital Paul Brousse, Villejuif, France.

Abstract

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.

KEYWORDS:

hepatocellular carcinoma; macrovascular invasion; propensity analysis; sorafenib; surgical resection

PMID:
28609020
DOI:
10.1111/liv.13491
[Indexed for MEDLINE]

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