Mehta N. Clin Gastroenterol Hepatol. 2013;11:572-578.
May 7, 2013
Patients with infiltrative hepatocellular carcinoma experienced prolonged survival when treated with transarterial chemoembolization or sorafenib in a recent retrospective cohort study.
Researchers evaluated data from 155 patients with infiltrative hepatocellular carcinoma (iHCC) seen at the University of California, San Francisco Medical Center between 2002 and 2010. Participants had a median age of 60 years, MELD score of 13, maximum tumor diameter of 11.3 cm and alpha-fetoprotein level of 347 ng/mL.
Nearly all patients (95.5%) had died as of Sept. 2011. The survival rate was 63% of patients at 3 months, 30% at 6 months and 8% at 12 months, with a median survival of 4.0 months across the cohort. Median survival was longer among patients who underwent treatment, including transarterial chemoembolization (TACE, 6.0 months), sorafenib (7.5 months) or radiofrequency ablation with or without TACE (9.2 months), than patients who did not receive treatment (3 months).
Survival rates were significantly higher among patients treated with sorafenib (n=11, 73% at 6 and 36% at 12 months) and those who underwent transarterial chemoembolization (TACE, n=18, 45% and 17%) than participants who received no therapy (n=109, 17% and 2%) (P<.01 for all comparisons). No significant difference in survival was observed between those treated with sorafenib or TACE (P=.267).
Multivariate analysis indicated associations between mortality at 6 months and several factors, including: cirrhosis of Child-Pugh class B (HR=2.61, 1.36-4.8 vs. class A) or C (HR=6.12, 2.74-13.76 vs. class A); not having received sorafenib, radiofrequency ablation or transarterial chemoembolization (HR=2.79, 1.60-4.88); MELD score (HR=1.07, 1.03-1.12 per one-point increase); tumor size (HR=1.05, 1.01-1.10 per 1-cm increase) and an alfa-fetoprotein level above 1,000 ng/mL (HR=2.47, 1.56-3.84) (95% CI for all).
“iHCC is a radiographically distinct and advanced form of HCC,” the researchers wrote. “The majority of patients with iHCC have extensive tumor burden as well as macrovascular invasion. … The prognosis of patients who are diagnosed with iHCC is grim, with a median survival of only 4 months. Nonetheless, our results suggest that some patients may still derive survival benefit from liver-directed therapy and/or systemic therapy with sorafenib.”
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