Prognostic Impact of Metastatic Site in Patients Receiving First-Line Sorafenib Therapy for Advanced Hepatocellular Carcinoma.
Luca IelasiFrancesco TovoliMatteo TonniniBernardo StefaniniRaffaella TortoraGiulia MaginiRodolfo SaccoTiziana PressianiFranco TrevisaniIngrid GarajovàPiscaglia FabioAlessandro GranitoPublished in: Cancers (2023)
Extrahepatic spread is a well-known negative prognostic factor in patients with advanced hepatocellular carcinoma (HCC). The prognostic role of different metastatic sites and their response rate to systemic treatment is still being debated. We considered 237 metastatic HCC patients treated with sorafenib as first-line therapy in five different Italian centers from 2010 to 2020. The most common metastatic sites were lymph nodes, lungs, bone and adrenal glands. In survival analysis, the presence of dissemination to lymph nodes (OS 7.1 vs. 10.2 months; p = 0.007) and lungs (OS 5.9 vs. 10.2 months; p < 0.001) were significantly related to worse survival rates compared with all other sites. In the subgroup analysis of patients with only a single metastatic site, this prognostic effect remained statistically significant. Palliative radiation therapy on bone metastases significantly prolonged survival in this cohort of patients (OS 19.4 vs. 6.5 months; p < 0.001). Furthermore, patients with lymph node and lung metastases had worse disease control rates (39.4% and 30.5%, respectively) and shorter radiological progression-free survival (3.4 and 3.1 months, respectively). In conclusion, some sites of an extrahepatic spread of HCC have a prognostic impact on survival in patients treated with sorafenib; in particular, lymph nodes and lung metastases have worse prognosis and treatment response rate.
Keyphrases
- lymph node
- free survival
- squamous cell carcinoma
- prognostic factors
- small cell lung cancer
- radiation therapy
- sentinel lymph node
- neoadjuvant chemotherapy
- end stage renal disease
- ejection fraction
- chronic kidney disease
- newly diagnosed
- stem cells
- palliative care
- randomized controlled trial
- mesenchymal stem cells
- radiation induced
- patient reported outcomes
- replacement therapy
- postmenopausal women