Role of local treatment including radiotherapy in barcelona clinic of liver cancer stage c patients

A nationwide cohort analysis in south korea

Jeongshim Lee, Won Sup Yoon, Woong Sub Koom, Chai Hong Rim

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalCancer Management and Research
Volume11
DOIs
Publication statusPublished - 2019 Jan 1

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Republic of Korea
Liver Neoplasms
Cohort Studies
Radiotherapy
Hepatocellular Carcinoma
Therapeutics
Neoplasm Metastasis
Survival
sorafenib
Registries
Lymph Nodes

Keywords

  • BCLC C
  • Hepatocellular carcinoma
  • Radiation therapy
  • Sorafenib
  • Survival

ASJC Scopus subject areas

  • Oncology

Cite this

Role of local treatment including radiotherapy in barcelona clinic of liver cancer stage c patients : A nationwide cohort analysis in south korea. / Lee, Jeongshim; Yoon, Won Sup; Koom, Woong Sub; Rim, Chai Hong.

In: Cancer Management and Research, Vol. 11, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Role of local treatment including radiotherapy in barcelona clinic of liver cancer stage c patients: A nationwide cohort analysis in south korea",
abstract = "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 = "BCLC C, Hepatocellular carcinoma, Radiation therapy, Sorafenib, Survival",
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AU - Yoon, Won Sup

AU - Koom, Woong Sub

AU - Rim, Chai Hong

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - BCLC C

KW - Hepatocellular carcinoma

KW - Radiation therapy

KW - Sorafenib

KW - Survival

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