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Radioembolization vs sorafenib in locally advanced hepatocellular carcinoma with portal vein tumor thrombosis: A propensity score and B ayesian analysis
Author(s) -
Martelletti Carolina,
Ricotti Andrea,
Gesualdo Marcantonio,
Carucci Patrizia,
Gaia Silvia,
Rolle Emanuela,
Burlone Michela Emma,
Okolicsanyi Stefano,
Mattalia Alberto,
Pirisi Mario,
Berchialla Paola,
Tabone Marco
Publication year - 2021
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.13030
Subject(s) - sorafenib , medicine , propensity score matching , hepatocellular carcinoma , portal vein thrombosis , surgery , thrombosis , oncology
Objective In this study we aimed to compare patient outcomes between the use of transarterial radioembolization (TARE) and sorafenib in patients with hepatocellular carcinoma (HCC) and intrahepatic portal vein tumor thrombosis (PVTT). Methods A total of 65 patients with HCC and intrahepatic PVTT treated in five Italian hospitals between 2012 and 2018 were included in the analysis. Those with any previous treatment, extension of PVTT to the main portal tract and extrahepatic involvement were excluded. Propensity score matching analysis and Bayesian model averaging analysis were performed. Results Of the 41 patients treated with TARE and 24 with sorafenib, 11 patients were downstaged to curative‐intent surgery (liver transplant in three and hepatectomy in eight), including 10 treated with TARE and one with sorafenib. TARE was more effective than sorafenib in downstaging patients to surgery, achieving a mean survival of 54 months. In the 54 patients without downstaging after treatment, of whom 31 were treated with TARE and 23 with sorafenib, median survival was 20.3 and 9.1 months, respectively ( P = 0.001), with different 1‐, 2‐ and 3‐year OS rates (64.5%, 42.6% and 37.3% vs 39.1%, 13.0% and 0%). Both propensity score and Bayesian model averaging confirmed an improvement in overall survival in the TARE group compared with sorafenib treatment. Conclusions TARE was more effective than sorafenib in downstaging patients with HCC to surgery, providing a significant improvement in survival. Even in patients who were not downstaged to surgery, survival appeared to be superior with TARE over sorafenib.