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Poor prognosis of infiltrative HCC improved with tumor-directed therapy
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Despite a poor prognosis, improved survival was observed among patients with infiltrative hepatocellular carcinoma after sorafenib or transarterial chemoembolization therapy in a recent study.
Researchers evaluated data from 155 patients with a radiographic diagnosis of infiltrative hepatocellular carcinoma (iHCC) between 2002 and 2010. The cohort (median age, 60 years; 79% men) had a median alpha-fetoprotein level of 347 ng/mL and a median MELD score of 13.
“iHCC accounts for approximately 10-15% of new HCC diagnoses, and yet precious little is known about this disease entity,” researcher Neil Mehta, MD, department of gastroenterology and hepatology at the University of California, San Francisco, told Healio.com. “We are often faced with the dilemma of whether patients with iHCC actually derive benefit from tumor-directed treatments, and so this became a focus of our study.”
Seventy percent of patients had stage C and 22% had stage D tumors (median maximum diameter, 11.3 cm). The majority of patients had macrovascular invasion (81.9%), all with portal vein tumor thrombosis, and 41% of observed lesions were hypovascular.
Median survival was 4 months, with rates of 30% at 6 months and 8% at 12 months. Tumor-directed therapy was performed in 46 cases, with transarterial chemoembolization alone (TACE, n=18) and sorafenib alone (n=11) the most common approaches.
Multivariate analysis indicated significant associations between mortality at 6 months and cirrhosis of Child-Turcotte-Pugh class C (HR=6.12; 95% CI, 2.74-13.76 compared with class A) or B (HR=2.61; 95% CI, 1.36-4.8); not having undergone treatment (HR=2.79; 95% CI, 1.6-4.88); alpha-fetoprotein levels above 1,000 ng/mL (HR=2.47; 95% CI, 1.56-3.84); plus female sex, MELD score and maximum tumor diameter.
“iHCC typically presents at a very advanced stage and carries a poor prognosis,” Mehta said. “In our study, iHCC patients on average had a survival of only about 4 months. However, just as in noninfiltrative hepatocellular carcinoma, tumor-directed therapies such as sorafenib or loco-regional therapy with chemoembolization did appear to improve overall survival by about 3 to 4.5 months, even after controlling for other factors.”
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