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Intermediate-advanced hepatocellular carcinoma in Argentina: Treatment and survival analysis.

Abstract：

BACKGROUND:Hepatocellular carcinoma (HCC) represents the sixteenth most frequent cancer in Argentina. The rise of new therapeutic modalities in intermediate-advanced HCC opens up a new paradigm for the treatment of HCC. AIM:To describe real-life treatments performed in patients with intermediate-advanced HCC before the approval of new systemic options. METHODS:This longitudinal observational cohort study was conducted between 2009 and 2016 in 14 different regional hospitals from Argentina. Included subjects had intermediate-advanced Barcelona Clinic Liver Cancer (BCLC) HCC stages (BCLC B to D). Primary end point analyzed was survival, which was assessed for each BCLC stage from the date of treatment until last patient follow-up or death. Kaplan Meier survival curves and Cox regression analysis were performed, with hazard ratios (HR) calculations and 95% confidence intervals (95%CI). RESULTS:From 327 HCC patients, 41% were BCLC stage B, 20% stage C and 39% stage D. Corresponding median survival were 15 mo (IQR 5-26 mo), 5 mo (IQR 2-13 mo) and 3 mo (IQR 1-13 mo) (P < 0.0001), respectively. Among BCLC-B patients (n = 135), 57% received TACE with a median number of 2 sessions (IQR 1-3 sessions). Survival was significantly better in BCLC-B patients treated with TACE HR = 0.29 (CI: 0.21-0.40) than those without TACE. After tumor reassessment by RECIST 1.1 criteria following the first TACE, patients with complete response achieved longer survival [HR = 0.15 (CI: 0.04-0.56, P = 0.005)]. Eighty-two patients were treated with sorafenib, mostly BCLC-B and C (87.8%). However, 12.2% were BCLC-D. Median survival with sorafenib was 4.5 mo (IQR 2.3-11.7 mo); which was lower among BCLC-D patients 3.2 mo (IQR 2.0-14.1 mo). A total of 36 BCLC-B patients presented tumor progression after TACE. In these patients, treatment with sorafenib presented better survival when compared to those patients who received sorafenib without prior TACE [HR = 0.26 (CI: 0.09-0.71); P = 0.013]. CONCLUSION:In this real setting, our results were lower than expected. This highlights unmet needs in Argentina, prior to the introduction of new treatments for HCC.

journal_name

World J Gastroenterol

journal_title

World journal of gastroenterology

authors

Piñero F,Marciano S,Fernández N,Silva J,Anders M,Zerega A,Ridruejo E,Romero G,Ameigeiras B,D'Amico C,Gaite L,Bermúdez C,Reggiardo V,Colombato L,Gadano A,Silva M

doi

10.3748/wjg.v25.i27.3607

subject

Has Abstract

pub_date

2019-07-21 00:00:00

pages

3607-3618

issue

eissn

1007-9327

issn

2219-2840

journal_volume

pub_type

杂志文章,多中心研究

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Intermediate-advanced hepatocellular carcinoma in Argentina: Treatment and survival analysis.