Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2016; 22(23): 5384-5392
Published online Jun 21, 2016. doi: 10.3748/wjg.v22.i23.5384
Adjuvant sorafenib after heptectomy for Barcelona Clinic Liver Cancer-stage C hepatocellular carcinoma patients
Feng Xia, Li-Li Wu, Wan-Yee Lau, Hong-Bo Huan, Xu-Dong Wen, Kuan-Sheng Ma, Xiao-Wu Li, Ping Bie
Feng Xia, Li-Li Wu, Hong-Bo Huan, Xu-Dong Wen, Kuan-Sheng Ma, Xiao-Wu Li, Ping Bie, Institute of Hepatobiliary Surgery, Southwest Hospital, Southwest Cancer Center, Third Military Medical University, Chongqing 400038, China
Wan-Yee Lau, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
Author contributions: Xia F and Wu LL contributed equally to the study; Xia F, Lau WY and Bie P contributed to study conception and design; Wu LL, Huan HB and Wen XD contributed to acquisition of data; Xia F, Lau WY and Li XW contributed to analysis and interpretation of data; Xia F and Wu LL drafted the manuscript; Lau WY and Bie P made critical revision of the manuscript for important intellectual content; Xia F, Wu LL and Wen XD made statistical analysis; Xia F and Bie P obtained funding and supervised the study.
Supported by Key Laboratory of Tumor Immunology and Pathology of Ministry of Education No. 2012jsz108; and the National Natural Sciences Foundation of China No. 81272224.
Institutional review board statement: This study was carried out with pre-approval given by the Ethics Committee of the Southwest Hospital, in accordance with its conformation to the ethical guidelines of the 1975 Helsinki Declaration.
Informed consent statement: Written informed consent was obtained from all patients for their data to be used for research purposes.
Conflict-of-interest statement: The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Feng Xia, MD, PhD, Professor of Surgery, Institute of Hepatobiliary Surgery, Southwest Hospital, Southwest Cancer Center, Third Military Medical University, No. 30 Gaotanyanzhengjie, Chongqing 400038, China. txzzxf@163.com
Telephone: +86-23-68765797 Fax: +86-23-65462170
Received: March 4, 2016
Peer-review started: March 7, 2016
First decision: March 21, 2016
Revised: March 27, 2016
Accepted: April 20, 2016
Article in press: April 20, 2016
Published online: June 21, 2016
Processing time: 100 Days and 11.4 Hours
Abstract

AIM: To investigate the efficacy and safety of adjuvant sorafenib after curative resection for patients with Barcelona Clinic Liver Cancer (BCLC)-stage C hepatocellular carcinoma (HCC).

METHODS: Thirty-four HCC patients, classified as BCLC-stage C, received adjuvant sorafenib for high-risk of tumor recurrence after curative hepatectomy at a tertiary care university hospital. The study group was compared with a case-matched control group of 68 patients who received curative hepatectomy for HCC during the study period in a 1:2 ratio.

RESULTS: The tumor recurrence rate was markedly lower in the sorafenib group (15/34, 44.1%) than in the control group (51/68, 75%, P = 0.002). The median disease-free survival was 12 mo in the study group and 10 mo in the control group. Tumor number more than 3, macrovascular invasion, hilar lymph nodes metastasis, and treatment with sorafenib were significant factors of disease-free survival by univariate analysis. Tumor number more than 3 and treatment with sorafenib were significant risk factors of disease-free survival by multivariate analysis in the Cox proportional hazards model. The disease-free survival and cumulative overall survival in the study group were significantly better than in the control group (P = 0.034 and 0.016, respectively).

CONCLUSION: Our study verifies the potential benefit and safety of adjuvant sorafenib for both decreasing HCC recurrence and extending disease-free and overall survival rates for patients with BCLC-stage C HCC after curative resection.

Keywords: Hepatectomy; Hepatocellular carcinoma; Sorafenib; Survival; Tumor recurrence

Core tip: Hepatocellular carcinoma (HCC) has a 5-year recurrence rate reaching 80%-90% even after potentially curative treatment. Therefore, it is extremely important to prevent recurrence for the prognosis of HCC patients. Sorafenib is the only approved treatment for patients with advanced HCC. Thus, based on the action of sorafenib, namely inhibition of tumor cell proliferation and angiogenesis, there is rationale for the study of sorafenib as an adjuvant therapy in HCC. It is essential to investigate the efficacy and safety of adjuvant sorafenib administered following curative resection in patients with Barcelona Clinic Liver Cancer-stage C HCC.