Overall survival in response to sorafenib with transarterial chemoembolization for BCLC stage B hepatocellular carcinoma: propensity score analysis

Objective: Barcelona clinic liver cancer (BCLC) stage B hepatocellular carcinoma (HCC) is a heterogeneous disease group. Transarterial chemoembolization (TACE) is indicated for BCLC stage B HCC, while sorafenib is indicated for BCLC stage C HCC. This study aimed to evaluate the efficacy of TACE+sorafenib compared with TACE monotherapy in the treatment of BCLC stage B HCC. Materials: Patients with BCLC stage B unresectable HCC. Methods: This was a retrospective study in patients with BCLC stage B HCC who received TACE (n = 144) or TACE+sorafenib (n = 46) between January 2008 and January 2014. Child-Pugh classification, history of hepatitis or cirrhosis, nodule number, tumor vascularity, ECOG performance status, adverse events, and survival were evaluated. Patients were matched 1 : 1 using the propensity score approach. Results: Median overall survival (OS) was 18.0 months in the TACE+sorafenib group compared with 10.0 months for TACE (p = 0.002). In matched patients, multivariate analysis showed that the use of TACE+sorafenib (HR = 0.351, 95%CI: 0.215-0.574, p < 0.001) and multiple-diffuse nodules (HR = 0.497, 95% CI: 0.293 - 0.884, p = 0.010) were independently associated with a better prognosis. Subgroup analysis showed survival benefits for patients with Child-Pugh A classification (p = 0.001), cirrhosis (p = 0.001), hepatitis B (p < 0.001), hypovascular lesion (p = 0.001), and both single/multiple nodules p = 0.001). Cumulative rates of adverse events were similar between the two groups (p = 0.155), but hand-foot syndrome (58.7% vs. 12.5%, p < 0.001) and diarrhea (60.9% vs. 40.3%, p = 0.02) were more frequent in the TACE+sorafenib group. Conclusions: The combination of TACE+sorafenib might improve the OS of patients with BCLC stage B HCC. These results also suggest that some subsets of patients could benefit more from the TACE+sorafenib combination.