Role of local treatment including radiotherapy in Barcelona Clinic of Liver Cancer stage C patients: a nationwide cohort analysis in South Korea
Received 7 November 2018
Accepted for publication 17 January 2019
Published 11 February 2019 Volume 2019:11 Pages 1373—1382
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Chien-Feng Li
Jeongshim Lee,1,2 Won Sup Yoon,3 Woong Sub Koom,1 Chai Hong Rim3
1Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea; 3Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea
On behalf of the Korean Liver Cancer Study Group
Purpose: Sorafenib is recommended as the standard treatment for hepatocellular carcinoma (HCC) of Barcelona Clinic of Liver Cancer stage C (BCLC C). However, local treatment including radiation therapy (LRT) is also widely administered in practice. The aim of our study was to define the role of LRT among BCLC C patients.
Patients and methods: Of the patients with HCC enrolled the Korean Central Cancer Registry from 2008 to 2014, the Korean Liver Cancer Study Group randomly extracted 10,580 patient data from ~50 hospitals nationwide. Among them, 3,401 patients were categorized to have BCLC C HCC. Among them, patients with information on initial treatments, defined as the first and secondary treatment within 60 days after the first treatment, were selected and classified into three initial treatment groups: LRT, sorafenib, and no treatment.
Results: Among 3,401 BCLC C HCC patients, 1,486 were included in the study and the remaining patients were excluded as they did not meet the criteria (eg, underwent local treatments without radiotherapy [RT] or received chemotherapy other than sorafenib). Of these, 266 were assigned to LRT (17.9%), 316 to sorafenib (21.3%), and 904 to no treatment group (60.8%). Median survival time of the sorafenib group was shorter than that of the LRT group (3.8 vs 7.6 months, P<0.001). In multivariable analysis, sorafenib group showed significantly higher risk related to mortality compared to LRT group, not only among all patients (HR: 1.50, 95% CI: 1.23–1.84) but also between subgroup cohorts with portal invasions (1.55, 1.23–1.84), with lymph node metastases (2.42, 1.53–3.83), without distant metastases (1.43, 1.10–1.87), and with distant metastases (1.57, 1.13–2.19). Additionally, no treatment group showed the worst survival among the three treatment groups not only in all patients, but also in all subgroups of patients (P<0.001 in all).
Conclusion: LRT as an initial treatment showed survival benefit as compared to sorafenib in HCC patients of BCLC C.
Keywords: hepatocellular carcinoma, BCLC C, sorafenib, radiation therapy, survival
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