Effectiveness of Transarterial Chemoembolization-First Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

Sung Won Chung; Min Kyung Park; Young Youn Cho; Youngsu Park; Cheol-Hyung Lee; Hyunwoo Oh; Heejoon Jang; Minseok Albert Kim; Sun Woong Kim; Joon Yeul Nam; Yun Bin Lee; Eun Ju Cho; Su Jong Yu; Hyo-Cheol Kim; Yoon Jun Kim; Jin Wook Chung; Jung-Hwan Yoon; Jeong-Hoon Lee

doi:10.2147/JHC.S294440

Effectiveness of Transarterial Chemoembolization-First Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

J Hepatocell Carcinoma. 2021 Jun 15:8:587-598. doi: 10.2147/JHC.S294440. eCollection 2021.

Authors

Sung Won Chung^#¹, Min Kyung Park^#¹, Young Youn Cho^#^{1

2}, Youngsu Park¹, Cheol-Hyung Lee¹, Hyunwoo Oh¹, Heejoon Jang¹, Minseok Albert Kim¹, Sun Woong Kim¹, Joon Yeul Nam¹, Yun Bin Lee¹, Eun Ju Cho¹, Su Jong Yu¹, Hyo-Cheol Kim³, Yoon Jun Kim¹, Jin Wook Chung³, Jung-Hwan Yoon¹, Jeong-Hoon Lee¹

Affiliations

¹ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
² Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea.
³ Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

^# Contributed equally.

Abstract

Background: Still in real-world practice, advanced hepatocellular carcinoma (HCC) patients are treated with transarterial chemoembolization (TACE). This study compared the therapeutic effectiveness of initial TACE treatment and initial sorafenib treatment in advanced HCC patients.

Patient and methods: Advanced HCC patients initially treated with sorafenib or TACE were included in this study. Treatment crossover due to an unfavorable response to initial treatment was allowed. Propensity score (PS) matching was applied for balancing baseline characteristics. The primary outcome was overall survival (OS) and the secondary outcomes included tumor response.

Results: A total of 554 patients were included in this study: 85 were initially treated with sorafenib (the sorafenib-first group) and 469 with TACE (the TACE-first group). In the entire cohort, the TACE-first group was associated with lower risk of death [adjusted hazard ratio (HR)=0.75, P=0.04]. In the PS-matched cohort (85 patients per group), the TACE-first group showed longer OS than the sorafenib-first group in both univariable (HR=0.68, P=0.02) and multivariable analyses (adjusted HR=0.58, P=0.002). Specifically, within both the entire and the PS-matched cohorts, the TACE-first group showed longer OS in subgroups with major portal vein tumor thrombosis (HR=0.72, P=0.048; HR=0.52, P=0.003) or infiltrative HCC (HR=0.42, P<0.001; HR=0.30, P=0.004, respectively). The objective response rate was higher in the TACE-first group (29.3% vs 14.7%, P=0.03) within the PS-matched cohort.

Conclusion: For advanced HCC, initial TACE leads to longer OS with a more favorable tumor response than initial sorafenib treatment. Intrahepatic tumor control with initial locoregional therapy may be a potent strategy for advanced HCC.

Keywords: liver cancer; locoregional therapy; transarterial therapy; tyrosine kinase inhibitor.

Grants and funding

Funding sources did not involve in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication. The corresponding authors had full access to all study data and had final responsibility for the decision to submit for publication.