Transarterial chemoembolization with or without sorafenib for hepatocellular carcinoma: A real‑world propensity score‑matched study

^aDepartment of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; ^bSchool of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; ^cDepartment of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; ^dDivision of Hematology and Oncology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; ^eDepartment of Medical Imaging, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; ^fDivision of Gastroenterology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; ^gLiver Diseases Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; ^hSchool of Post‑Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan

 

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

 

Abstract

 

Objectives: Transarterial chemoembolization (TACE) or sorafenib may prolong survival in patients with unresectable hepatocellular carcinoma (HCC); however, whether their combination prolongs survival than TACE alone remains controversial. We aimed to compare the overall survival (OS) of patients with unresectable HCC treated with TACE plus sorafenib (TACE‑S) versus TACE alone. Materials and Methods: All patients with unresectable HCC who received TACE as the initial therapy between January 2006 and January 2017 at Taipei Tzu Chi Hospital were enrolled. We matched patients treated with TACE‑S and those treated with TACE alone (TACE) by performing propensity score matching at a 1:2 ratio. Our primary outcome was OS during a 10‑year follow‑up period, and represented as a hazard ratio calculated using Cox proportional hazard regression models. Results: Among 515 patients with unresectable HCC were treated initially with TACE, 56 receiving TACE‑S group and 112 receiving TACE alone (TACE group) were included in the primary outcome analysis. The TACE‑S group had significantly longer median OS than did the TACE group (1.55 vs. 0.32, years; P < 0.001), and the 5‑year OS rates was 10.7% in the TACE‑S group and 0.9% in the TACE group (P < 0.001). In multivariate analyses, patients with a lower Child–Pugh score, tumor size ≤5 cm, and no extrahepatic metastasis before treatment and those receiving antiviral agents and receiving TACE‑S had longer OS (all P < 0.001). Conclusion: Antiviral agents and the combination of TACE with sorafenib may improve the OS of patients with unresectable HCC.