Published online May 16, 2018. doi: 10.12998/wjcc.v6.i5.74
Peer-review started: January 13, 2018
First decision: February 27, 2018
Revised: March 4, 2018
Accepted: March 19, 2018
Article in press: March 20, 2018
Published online: May 16, 2018
Transcatheter arterial chemoembolization (TACE) is the standard treatment for mid-term [Barcelona Clinical Liver Cancer Stage B (BCLC-B)] hepatocellular carcinoma (HCC). However, it limited beneficial effect. In recent years, several reports described the outcome Sorafenib combined with TACE for hepatocellular carcinoma; however the results are inconsistent. Moreover, most of these studies were conducted in developed countries. For developing countries, the data was few.
The aging population is growing at a remarkable rate all over the world. HCC incidence and age have a certain relationship. The incidence of HCC is increasing year by year, threatening people’s health. HCC with occult onset has a high degree of malignancy and spread quickly, and the majority of patients who are diagnosed at a later stage can not undergo surgical resection. These patients who are not suitable for surgical treatment usually use TACE, which achieves a limited beneficial effect. Therefore, we conducted the study, retrospective study to evaluate the safety and efficacy of sorafenib plus TACE treatment for BCLC-B HCC in Chinese patients.
The aim of this study is to evaluate the safety and efficacy of sorafenib plus TACE treatment for BCLC-B HCC.
A retrospective comparative study collected data was conducted at the Second Affiliated Hospital of Kunming Medical University. Sixty-seven patients with BCLC-B HCC who were treated with sorafenib plus TACE or TACE alone between 2009 and 2011 were included in the study. Follow-up was until 2014. Two groups were defined in the experiment: the experimental group, treated with sorafenib plus TACE, and the control group, treated with standard TACE alone. Compared to the safety and effectiveness of the two groups.
The analysis showed that the median overall survival (mOS) of the experimental group was 35.2 mo, while that of the control group was 22.0 mo (P < 0.05). Meanwhile, sorafenib plus TACE showed higher incidence rates of rash, hand-foot syndrome (HFS), and hypertension (P < 0.05) than TACE treatment alone. The most common toxicities with sorafenib were rash (31.6%), HFS (39.5%) and hypertension (31.6%), but there were no intolerable adverse events.
TACE is the preferred treatment for BCLC-B HCC and is suitable for patients who can not undergo surgical resection or who can be resected but who can not tolerate surgery after further examination. However, TACE usually does not result in complete necrotic lesions. TACE generally induces tumor angiogenesis and stimulates tumor growth or metastasis; therefore, disease control is limited. Sorafenib can inhibit tumor cell proliferation and angiogenesis and delay the progression of the disease in HCC patients. Moreover, sorafenib can inhibit the growth of VEGF. Some scholars have studied the use of TACE plus sorafenib to reduce the excessive production of VEGF to compensate for this effect of TACE and improve the therapeutic effect. Therefore, we conducted this work. Sorafenib plus TACE treatment for BCLC-B HCC significantly prolonged the mOS of patients compared to TACE treatment alone. The most common toxicities with sorafenib were rash (31.6%), HFS (39.5%) and hypertension (31.6%), but there were no intolerable adverse events. The results of this study also showed that the Child-Pugh grade, tumor diameter and the combination treatment with sorafenib were three independent factors that affect the mOS. This study confirms that sorafenib plus TACE treatment for BCLC-B HCC significantly prolonged the mOS of patients compared to TACE treatment alone. Moreover, this new treatment approach showed tolerable toxicity. However, whether Sorafenib can be used in combination with TACE to improve the efficacy of BCLC-B HCC requires a prospective and large sample study.
Due to small sample sizes and retrospective studies, it can be difficult to draw reliable conclusions. In conclusion, our results confirm that sorafenib plus TACE treatment for BCLC-B HCC significantly prolonged the mOS of patients compared to TACE treatment alone. Moreover, this new treatment approach showed tolerable toxicity. This study provides important information for clinicians who are interested in using sorafenib plus TACE therapies to treat BCLC-B HCC.