PMID- 37345023 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230701 IS - 2072-6694 (Print) IS - 2072-6694 (Electronic) IS - 2072-6694 (Linking) VI - 15 IP - 10 DP - 2023 May 10 TI - Beneficial Effect of Combining Radiotherapy and Transarterial Chemoembolization on Patient Survival in Hepatocellular Carcinomas and Macrovascular Invasion Treated with Sorafenib. LID - 10.3390/cancers15102687 [doi] LID - 2687 AB - BACKGROUND: Approximately 10-40% of hepatocellular carcinoma (HCC) patients have definite vascular invasion at the time of diagnosis. Without curative treatment options, these patients have an abysmal prognosis with a median survival of only a few months following systemic therapy. However, supportive evidence of combining multiple locoregional treatments with systemic therapy is limited. This study compared the outcomes of sorafenib alone versus multimodality therapy with sorafenib, radiotherapy (RT), and transarterial chemoembolization (TACE) in advanced HCC patients with macrovascular invasion (MaVI). METHODS: The process took place over a nine-year period between March 2009 and October 2017, wherein 78 HCC patients with MaVI who underwent either sorafenib therapy alone (n = 49) or combined sorafenib/RT/TACE (n = 29) therapy were chosen for the retrospective study. We compared the overall survival (OS) between the two groups using the Cox regression hazard model and adjusted imbalances using propensity score matching (PSM). RESULTS: At the last follow-up, 76 patients had died, with a median follow-up time of 4.8 months for all patients and 31 months for those who were alive. Patients treated with sorafenib/RT/TACE had superior OS compared to those treated with sorafenib alone, showing a median survival of 9.3 vs. 2.7 months and a one-year survival of 37.1% vs. 6.1% (p < 0.001). In the multivariable analysis, new diagnosis or recurrence of HCC and treatment modalities (sorafenib alone vs. sorafenib/RT/TACE) were independent prognostic factors for OS. Compared to patients treated with sorafenib alone, significantly better OS was further verified using PSM (p < 0.001) in patients who received multiple therapeutic modalities. CONCLUSION: Multimodality therapy with sorafenib/RT/TACE increased OS threefold versus sorafenib therapy alone in HCC patients with MaVI. This study offers promising benefits of combined locoregional and systemic therapy for advanced HCC in current patient management and prospective clinical trials. FAU - Lu, Meng-Chuan AU - Lu MC AUID- ORCID: 0000-0003-2978-741X AD - Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Huang, Wen-Yen AU - Huang WY AD - Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Fan, Hsiu-Lung AU - Fan HL AD - Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Chen, Teng-Wei AU - Chen TW AD - Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Chang, Wei-Chou AU - Chang WC AD - Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Lin, Hsuan-Hwai AU - Lin HH AD - Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Shih, Yu-Lueng AU - Shih YL AUID- ORCID: 0000-0003-4629-4393 AD - Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Hsieh, Tsai-Yuan AU - Hsieh TY AD - Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. FAU - Huang, Wei-Chen AU - Huang WC AUID- ORCID: 0000-0002-9736-9933 AD - Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan. AD - Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Warren 1019A, 55 Fruit Street, Boston, MA 02114, USA. LA - eng GR - (NSTC- 111-2314-B-016-049)/National Science and Technology Council/ GR - (TSGH-C04-110030)/Tri-Service General Hospital Research Foundation/ PT - Journal Article DEP - 20230510 PL - Switzerland TA - Cancers (Basel) JT - Cancers JID - 101526829 PMC - PMC10216609 OTO - NOTNLM OT - hepatocellular carcinoma OT - macrovascular invasion OT - radiotherapy OT - sorafenib OT - survival OT - transarterial chemoembolization COIS- The authors declare no conflict of interest. EDAT- 2023/06/22 06:42 MHDA- 2023/06/22 06:43 PMCR- 2023/05/10 CRDT- 2023/06/22 01:00 PHST- 2023/03/31 00:00 [received] PHST- 2023/04/26 00:00 [revised] PHST- 2023/05/08 00:00 [accepted] PHST- 2023/06/22 06:43 [medline] PHST- 2023/06/22 06:42 [pubmed] PHST- 2023/06/22 01:00 [entrez] PHST- 2023/05/10 00:00 [pmc-release] AID - cancers15102687 [pii] AID - cancers-15-02687 [pii] AID - 10.3390/cancers15102687 [doi] PST - epublish SO - Cancers (Basel). 2023 May 10;15(10):2687. doi: 10.3390/cancers15102687.