Sorafenib Combined With Transarterial Chemoembolization For Advanced Hepatocellular Carcinoma

Background and Aims Data are lacking on the efficacy and safety of sorafenib incombination with transarterial chemoembolization (TACE) in patients with advancedhepatocellular carcinoma (HCC).Methods In the multicenter retrospective study,222consecutive HCC patients receivingthe combination therapy were enrolled between June2008and July2011.Results Chronic hepatitis B was the predominant cause of HCC (86%).80%patientswere in Barcelona Clinic Liver Cancer (BCLC) stage C and86%patients were atChild-Pugh (CP) A class. At baseline,91patients (41%) had macrovascular invasion.Extrahepatic metastasis was observed in67patients (30%). The overall median survivalwas12months (95%CI10.1-13.9). Survival rates of the entire cohort at1year and2years were47%and24%, respectively. The overall incidence of sorafenib relatedadverse events (AEs) was87%. There was no TACE procedure-related death. In177BCLC-C patients, ECOG performance status, the number of HCC nodules, Child-Pughscore and macrovascular invasion were significantly associated with overall survival andwere included in the final risk scores (R). R=5*(Vascular invasion:0if no,1yes)+ 6*(CP:0if A,1if B)+7*(No. of lesions:0if1-2,1≥3)+8*(ECOG:0if0,1≥1). Themedian survival for the C1group (17m) was significantly longer than that for the C2group (7.7m)(P<0.001).Conclusion Sorafenib in combination with TACE should be considered a safe andeffective therapy for advanced HCC. Further validation of the new subgroup of BCLC-Cstage is warranted in an independent patient cohort.