Intermediate-advanced hepatocellular carcinoma in Argentina: Treatment and survival analysis

PIÑERO, FEDERICO; MARCIANO, SEBASTIÁN; FERNÁNDEZ, NORA; SILVA, JORGE; ANDERS, MARGARITA; ZEREGA, ALINA; RIDRUEJO, EZEQUIEL; ROMERO, GUSTAVO; AMEIGEIRAS, BEATRIZ; D´AMICO, CLAUDIA; GAITE, LUIS; BERMÚDEZ, CARLA; REGGIARDO, VIRGINIA; COLOMBATO, LUIS; GADANO, ADRIÁN; SILVA, MARCELO

WORLD JOURNAL OF GASTROENTEROLOGY

W J G PRESS

Año: 2019 vol. 25 p. 3607 - 3618

1007-9327

BACKGROUNDHepatocellular carcinoma (HCC) represents the sixteenth most frequent cancer in Argentina. The rise of new therapeutic modalities in intermediate-advanced HCC opens up a new paradigm for the treatment of HCC.AIMTo describe real-life treatments performed in patients with intermediate-advanced HCC before the approval of new systemic options.METHODSThis longitudinal observational cohort study was conducted between 2009 and 2016 in 14 different regional hospitals from Argentina. Included subjects had intermediate-advanced Barcelona Clinic Liver Cancer (BCLC) HCC stages (BCLC B to D). Primary end point analyzed was survival, which was assessed for each BCLC stage from the date of treatment until last patient follow-up or death. Kaplan Meier survival curves and Cox regression analysis were performed, with hazard ratios (HR) calculations and 95% confidence intervals (95%CI).RESULTSFrom 327 HCC patients, 41% were BCLC stage B, 20% stage C and 39% stage D. Corresponding median survival were 15 mo (IQR 5-26 mo), 5 mo (IQR 2-13 mo) and 3 mo (IQR 1-13 mo) (P < 0.0001), respectively. Among BCLC-B patients (n = 135), 57% received TACE with a median number of 2 sessions (IQR 1-3 sessions). Survival was significantly better in BCLC-B patients treated with TACE HR = 0.29 (CI: 0.21-0.40) than those without TACE. After tumor reassessment by RECIST 1.1 criteria following the first TACE, patients with complete response achieved longer survival [HR = 0.15 (CI: 0.04-0.56, P = 0.005)]. Eighty-two patients were treated with sorafenib, mostly BCLC-B and C (87.8%). However, 12.2% were BCLC-D. Median survival with sorafenib was 4.5 mo (IQR 2.3-11.7 mo); which was lower among BCLC-D patients 3.2 mo (IQR 2.0-14.1 mo). A total of 36 BCLC-B patients presented tumor progression after TACE. In these patients, treatment with sorafenib presented better survival when compared to those patients who received sorafenib without prior TACE [HR = 0.26 (CI: 0.09-0.71); P = 0.013].CONCLUSIONIn this real setting, our results were lower than expected. This highlights unmet needs in Argentina, prior to the introduction of new treatments for HCC.