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Open Access Research article

Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: propensity score analysis

Takahide Nakazawa12*, Hisashi Hidaka1, Akitaka Shibuya1, Yusuke Okuwaki1, Yoshiaki Tanaka1, Juichi Takada1, Tsutomu Minamino1, Masaaki Watanabe1, Shigehiro Kokubu3 and Wasaburo Koizumi1

Author Affiliations

1 Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, 2-1-1 Asamizodai, Minami-ku, Sagamihara, Kanagawa 252-0380, Japan

2 Nakazawa Medical Clinic, Sagamihara, Japan

3 Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan

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BMC Gastroenterology 2014, 14:84  doi:10.1186/1471-230X-14-84

Published: 3 May 2014

Abstract

Background

This study investigated the survival benefits of sorafenib vs. radiotherapy (RT) in patients with unresectable hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) in the main trunk or the first branch.

Methods

Ninety-seven patients were retrospectively reviewed. Forty patients were enrolled by the Kanagawa Liver Study Group and received sorafenib, and 57 consecutive patients received RT in our hospital. Overall survival was compared between the two groups with PVTT by propensity score (PS) analysis. Factors associated with survival were evaluated by multivariate analysis.

Results

The median treatment period with sorafenib was 45 days, while the median total radiation dose was 50 Gy. The Child-Pugh class and the level of invasion into hepatic large vessels were significantly more advanced in the RT group than in the sorafenib group. Median survival did not differ significantly between the sorafenib group (4.3 months) and the RT group (5.9 months; P = 0.115). After PS matching (n = 28 per group), better survival was noted in the RT group than in the sorafenib group (median survival, 10.9 vs. 4.8 months; P = 0.025). A Cox model showed that des-γ-carboxy prothrombin <1000 mAU/mL at enrollment and RT were significant independent predictors of survival in the PS model (P = 0.024, HR, 0.508; 95% CI, 0.282 to 0.915; and P = 0.007, HR, 0.434; 95% CI, 0.235 to 0.779; respectively).

Conclusions

RT is a better first-line therapy than sorafenib in patients who have advanced unresectable HCC with PVTT.

Keywords:
Hepatocellular carcinoma; Overall survival; Portal venous tumor thrombosis; Radiotherapy; Sorafenib