Survival of patients with advanced hepatocellular carcinoma: Sorafenib versus other treatments

Background and Aim: Although sorafenib is recommended for patients with advanced hepatocellular carcinoma (HCC), a substantial portion of HCC patients in Asia are still treated with other treatments, mainly due to the prohibitive cost of sorafenib. We aimed to evaluate the clinical outcome of patients treated with sorafenib and those treated with other modalities in a single-center cohort. Methods: We reviewed the medical records of two groups of consecutive patients with advanced HCC, according to applied treatment modalities, between January 2007 and September 2009 as follows: patients who received sorafenib for 6 weeks or more (n = 123) and patients who were treated with one or more of other treatments, including transarterial chemoembolization, radiation, and cytotoxic chemotherapy (n = 253). Results: Overall survival did not differ significantly between these two groups (8.4 vs 8.2 months; P = 0.601). Significant prognostic factors were high alpha-fetoprotein (>= 200 ng/mL), massive/infiltrative intrahepatic tumors, macrovascular invasion, extrahepatic spread, and higher tumor-node-metastasis stage. Subgroup analysis, according to these factors, showed that sorafenib resulted in superior survival in patients with extrahepatic spread (hazard ratio [HR] = 0.539; P = 0.003) and massive/infiltrative tumors (HR = 0.680; P = 0.036). In the absence of each prognostic factor, other treatments were better than sorafenib. Conclusions: Considering the survival benefit for sorafenib over other treatments in patients with extrahepatic spread and massive/infiltrative intrahepatic tumors, these characteristics might be regarded as compelling indications for sorafenib.