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An Analysis for Survival Predictors for Patients with Hepatocellular Carcinoma Who Failed to Sorafenib Treatment in Pre-regorafenib Era

대한간암학회지 2019년 19권 2호 p.117 ~ 127
이찬욱 ( Lee Chan-Uk ) - Korea University College of Medicine Department of Internal Medicine

 ( Lee Young-Sun ) - Korea University College of Medicine Department of Internal Medicine
 ( Kim Ji-Hoon ) - Korea University College of Medicine Department of Internal Medicine
이민진 ( Lee Min-Jin ) - Korea University College of Medicine Department of Internal Medicine
김세화 ( Kim Se-Hwa ) - Korea University College of Medicine Department of Internal Medicine
 ( Jung Young-Kul ) - Korea University College of Medicine Department of Internal Medicine
 ( Seo Yeon-Seok ) - Korea University College of Medicine Department of Internal Medicine
 ( Yim Hyung-Joon ) - Korea University College of Medicine Department of Internal Medicine
 ( Yeon Jong-Eun ) - Korea University College of Medicine Department of Internal Medicine
 ( Byun Kwan-Soo ) - Korea University College of Medicine Department of Internal Medicine

Abstract


Background/Aims: Sorafenib is the standard treatment for patients with advanced hepatocellular carcinoma (HCC). We aimed to investigate the prognosis predictors and the role of second-line cytotoxic systemic chemotherapy (CSC) in patients with advanced HCC after sorafenib discontinuation in the pre-regorafenib era.

Methods: From 2007 to 2015 in the pre-regorafenib era, the medical records of 166 HCC patients, who had permanently discontinued sorafenib, were retrospectively reviewed. For further analysis of survival factors after sorafenib treatment failure, we compared the survival of patients who had maintained liver function after second-line treatment with the best supportive care (BSC) group and selective BSC (SBSC) group.

Results: After discontinuation of sorafenib, median overall survival (OS) was 2.8 (1.9-3.7) months. The OS in patients who discontinued sorafenib due to adverse effect, progression, and poor clinical condition were 5.5 (2.4-8.6), 5.5 (2.2-8.9), and 0.9 (0.5-1.3) months, respectively (P<0.001). The independent predictive factors of survival after sorafenib failure were serum level of bilirubin and albumin, α-fetoprotein, discontinuation cause, and second-line CSC. In comparison with survival between second-line CSC and BSC group, the CSC group showed better survival outcome compared to the BSC group (10.6 vs. 1.6 months, P<0.001) and SBSC group (10.6 vs. 4.2 months, P=0.023).

Conclusions: The survival after sorafenib failure in patients who discontinued sorafenib due to progression and adverse effects was significantly better than in those who discontinued treatment due to clinical deterioration. In the pre-regorafenib era, patients who received second-line CSC showed better survival than those who received only supportive care after sorafenib failure.

키워드

Hepatocellular carcinoma; Sorafenib; Chemotherapy
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