A Simple Score to Select Sorafenib Treatment Candidates: A Report from the South American Liver Research Network

LEATHERS, JAMES S.; BALDERRAMO, DOMINGO; PRIETO, JHON E.; DIEHL, FERNANDO; GONZALEZ BALLERGA, ESTEBAN; FERREIRO, MELINA R.; CARRERA, ENRIQUE; BARREYRO, FERNANDO J.; DIAZ FERRER, JAVIER; SINGH, DUPINDER; MATTOS, ANGELO Z.; CARRILHO, FLAIR J.; DEBES, JOSE D.

Punta Cana

Congreso; XXV Congreso, Asociación Latinoamericana para el Estudio del Hígado (ALEH); 2018

Asociación Latinoamericana para el Estudio del Hígado (ALEH)

Introduction: Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. Sorafenib, a multiple tyrosine kinase inhibitor, remains the standard of treatment for patients with inoperable or advanced HCC. However, due to a modest survival benefit, as well as the limiting cost of sorafenib in certain regions, proper patient selection for treatment is essential. The evaluation of the criteria of the Barcelona Clinic LIver Cancer (BCLC) in limited resource settings is often unattainable due to a variety of reasons. To do this, and using a cohort of the South American liver research network (1336 cases of HCC), we created a simple and economical prognostic scoring system to help identify patients who are likely to have a survival benefit in treatment with sorafenib , using simple laboratory variables such as Platelet, protrombin time by RIN and total bilirubin (PIB). Methods: In order to design the PIB score, we assign each patient of the sorafenib cohort, with available laboratory and survival data, one point for each of the following: total bilirubin ≤ 3.0 mg / dL, platelets ≤ 250 × 109 / L, (3) and RIN ≤ 1.6, following the methodology described above by Di Constanzo et al. The GDP score has a score range from 0 to 3. Central tendency measures were expressed as medians (Q1 - Q3). Kaplan-Meyer survival curves were constructed to graphically compare scores. The risk ratios were obtained using Cox proportional risk regression with the Breslow method. The log-rank test was used to assess the equality of survival functions. A level of evidence of p ≤ 0.05 was taken as a criterion of significance. The STATA V statistical package was used. 14.2. Results: Of the total of 1336 patients with HCC, 127 patients were treated with sorafenib. Of these, 86 had complete laboratory and survival data. The epidemiological characteristics are shown in Table 1. The median age was 64 years (IQR: 55-71) and 67% male. Hepatitis C infection was the most common etiology of HCC (42%). Sixty-three patients (76%) died during the period of obsessional study. The median survival time after the start of treatment with sorafenib was 7.5 months (IQR 2-17). There were no patients with a PIB score of "0", five patients with a score of "1", 21 patients with a score of "2" and 61 patients with a score of "3". Patients with a PIB score of "1" or "2" had a median survival of 2 months (IQR 1-8 and 2-7, respectively). Patients with a GDP score of "3" had a median survival of 10.5 months (IQR 4-21). The increase in the GDP score was significantly associated with better survival (HR 0.44 [0.29, 0.65], P