Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2016; 22(15): 4034-4040
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.4034
Sorafenib after resection improves the outcome of BCLC stage C hepatocellular carcinoma
Jiang Li, Yu Hou, Xiao-Bei Cai, Bin Liu
Jiang Li, Xiao-Bei Cai, Bin Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
Yu Hou, Department of Oncology Radiotherapy, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan province, Kunming 650181, Yunnan Province, China
Author contributions: Li J and Hou Y contributed equally to this work; Li J and Hou Y designed the study and analyzed the data; Li J, Hou Y, and Cai XB acquired data and drafted the manuscript; Li J, Hou Y, and Liu B defined the intellectual content; Cai XB researched literature; Liu B provided administrative, technical, and material support and critically revised the manuscript; all authors guarantee the integrity of the entire study and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Kunming Medical University Institutional Review Board.
Informed consent statement: This is a retrospective study, informed consent is not required.
Conflict-of-interest statement: None declared.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bin Liu, MD, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming 650032, Yunnan Province, China. 13888836057@163.com
Telephone: +86-871-65355319 Fax: +86-871-65357191
Received: July 1, 2015
Peer-review started: July 4, 2015
First decision: August 26, 2015
Revised: October 27, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: April 21, 2016
Processing time: 277 Days and 2.7 Hours
Abstract

AIM: To evaluate whether sorafenib use after resection impacts tumor relapse and survival in Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC).

METHODS: This retrospective study enrolled 36 male BCLC stage C HCC patients with portal vein thrombus and Child-Pugh class A liver function. Twenty-four patients received only surgical resection (SR), and 12 patients received oral sorafenib within 30 d after surgery. The primary outcomes were time to progression (TTP) (the time from surgical resection until HCC recurrence or extrahepatic metastases) and overall survival (OS). The secondary outcome was the rate of postoperative recurrence or metastasis. TTP and OS were analyzed using Kaplan Meier curves.

RESULTS: There were no significant differences between the two groups in the serum levels of alpha-fetoprotein, copies of hepatitis B virus-DNA, preoperative laboratory results, degree of hepatic fibrosis, types of portal vein tumor thrombus, number of satellite lesions, tumor diameter, pathological results, volume of blood loss, volume of blood transfusion, or surgery time (all P > 0.05). Patients in the SR + sorafenib group had a significantly longer TTP (29 mo vs 22 mo, P = 0.041) and a significantly longer median OS (37 mo vs 30 mo, P = 0.01) compared to patients in the SR group. The SR group had 18 cases (75%) of recurrence/metastasis while the SR + sorafenib group had six cases (50%) of recurrence/metastasis. A total of 19 patients died after surgery (five in the SR + sorafenib group and 14 in the SR group). The most common sorafenib-related adverse events were skin reactions, diarrhea, and hypertension, all of which were resolved with treatment.

CONCLUSION: Sorafenib after SR was well-tolerated. Patients who received sorafenib after SR had better outcomes compared to patients who received only SR.

Keywords: Hepatocellular carcinoma; Survival; Hepatic resection; Sorafenib; Recurrence

Core tip: Barcelona Clinic Liver Cancer stage C patients with portal vein thrombus and Child-Pugh class A liver function who received sorafenib after surgical resection had significantly longer overall survival (37 mo vs 20 mo, P = 0.01) and significantly longer time to progression compared to patients who received only resection (29 mo vs 22 mo, P = 0.041). Our data suggested that better outcomes can be achieved with sorafenib after surgical resection, rather than sorafenib monotherapy.