Background: Still in real-world practice, advanced hepatocellular carcinoma (HCC) patients are treated with transarterial chemoembolization (TACE). This study compared the therapeutic effectiveness of initial TACE treatment and initial sorafenib treatment in advanced HCC patients.
Patient and Methods: Advanced HCC patients initially treated with sorafenib or TACE were included in this study. Treatment crossover due to an unfavorable response to initial treatment was allowed. Propensity score (PS) matching was applied for balancing baseline characteristics. The primary outcome was overall survival (OS) and the secondary outcomes included tumor response.
Results: A total of 554 patients were included in this study: 85 were initially treated with sorafenib (the sorafenib-first group) and 469 with TACE (the TACE-first group). In the entire cohort, the TACE-first group was associated with lower risk of death [adjusted hazard ratio (HR)=0.75, P=0.04]. In the PS-matched cohort (85 patients per group), the TACE-first group showed longer OS than the sorafenib-first group in both univariable (HR=0.68, P=0.02) and multivariable analyses (adjusted HR=0.58, P=0.002). Specifically, within both the entire and the PS-matched cohorts, the TACE-first group showed longer OS in subgroups with major portal vein tumor thrombosis (HR=0.72, P=0.048; HR=0.52, P=0.003) or infiltrative HCC (HR=0.42, P< 0.001; HR=0.30, P=0.004, respectively). The objective response rate was higher in the TACE-first group (29.3% vs 14.7%, P=0.03) within the PS-matched cohort.
Conclusion: For advanced HCC, initial TACE leads to longer OS with a more favorable tumor response than initial sorafenib treatment. Intrahepatic tumor control with initial locoregional therapy may be a potent strategy for advanced HCC.



中文翻译：

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晚期肝细胞癌经动脉化疗栓塞优先治疗的有效性：倾向评分匹配分析

背景：仍在现实世界中，晚期肝细胞癌 (HCC) 患者接受经动脉化疗栓塞 (TACE) 治疗。本研究比较了初始 TACE 治疗和初始索拉非尼治疗对晚期 HCC 患者的治疗效果。
患者和方法：本研究包括最初用索拉非尼或 TACE 治疗的晚期 HCC 患者。允许由于对初始治疗的不利反应而导致的治疗交叉。应用倾向评分 (PS) 匹配来平衡基线特征。主要结果是总生存期 (OS)，次要结果包括肿瘤反应。
结果：本研究共纳入 554 名患者：85 名患者最初接受索拉非尼治疗（索拉非尼优先组），469 名接受 TACE 治疗（TACE 优先组）。在整个队列中，TACE 优先组与较低的死亡风险相关 [调整后的风险比 (HR) = 0.75，P = 0.04]。在 PS 匹配的队列中（每组 85 名患者），在单变量（HR=0.68，P =0.02）和多变量分析（调整后的 HR=0.58，P = 0.002）。具体而言，在整个队列和 PS 匹配队列中，TACE 优先组在门静脉主要肿瘤血栓形成亚组中显示出更长的 OS（HR=0.72，P =0.048；HR=0.52，P=0.003) 或浸润性 HCC（分别为 HR=0.42，P < 0.001；HR=0.30，P =0.004）。在 PS 匹配队列中，TACE 优先组的客观缓解率更高（29.3% 对 14.7%，P = 0.03）。
结论：对于晚期 HCC，初始 TACE 导致更长的 OS，比初始索拉非尼治疗更有利的肿瘤反应。通过初始局部治疗控制肝内肿瘤可能是晚期 HCC 的有效策略。