Hepatectomy combined with sorafenib in patients with intermediate-advanced hepatocellullar carcinoma

Purpose: To evaluate the efficacy and tolerability of hepatectomy in combination with sorafenib in the treatment of intermediate-advanced hepatocellular carcinoma (HCC). Methods: One hundred and eighty-sixty consecutive patients with intermediate-advanced HCC who were treated with sorafenib were enrolled in this study. They were divided into two groups: sorafenib group (39) and hepatectomy combined with sorafenib group (147). Survival rates of the patients were analyzed by the Kaplan-Meier method. Cox's proportional hazards model was used to analyze variables associated with survival. Adverse events induced by sorafenib were observed and recorded. Results: The median follow-up duration was 13.0 months (range 1-41). There were 77 patients with intermediate HCC (BCLC stage B) (41.4%) and 109 patients with advanced HCC (BCLC stage C) (58.6%). The overall survival was greater in patients with intermediate HCC than in patients with advanced HCC (p=0.011). Surgery before administration of sorafenib did not contribute to overall survival of patients with intermediate HCC (p=0.312). For patients with advanced HCC, the survival of those who underwent surgery before sorafenib was significantly longer than that of patients who received sorafenib alone (15.0 months, 95% CI 12.3-17.7 vs. 8.0 months, 95% CI 5.5-10.5; p=0.024) and surgery before sorafenib was identified as the only predictor of survival for patients with advanced HCC (HR, 0.582; 95% CI, 0.353-0.932; p=0.035). Conclusions: The combination of surgery and sorafenib is safe and significantly prolongs overall survival of patients with advanced HCC.