Evaluating the effect of intrahepatic lesion status on the prognosis of advanced hepatocellular carcinoma patients with extrahepatic metastasis: A prospective multicenter cohort study

Abstract

Sorafenib is an oral multikinase inhibitor that has been approved to treat advanced hepatocellular carcinoma (HCC), although it is unclear whether the intrahepatic lesion is associated with prognosis of advanced HCC patients with extrahepatic metastasis treated with sorafenib. This study aimed to assess survival risk factors and evaluate therapeutic strategies for advanced HCC patients with extrahepatic metastasis treated with sorafenib. We analyzed the clinical data and treatment outcomes for 524 consecutive advanced HCC patients treated with sorafenib. Among them, 288 (55%) patients had extrahepatic metastasis. Among the patients with extrahepatic metastasis, 212 (74%) also had intrahepatic lesion. Multivariate analyses of overall survival identified intrahepatic lesion as an independent risk factor in patients with extrahepatic metastasis. Of those, 106 (50%) were treated with sorafenib monotherapy and 106 (50%) with alternatives to sorafenib treatment. The median survival time was 6.1 months for patients with sorafenib monotherapy and 11.6 months for those administered alternative treatments (p=0.0015). Our results indicated that sorafenib treatment may have negative long-term therapeutic effects in advanced HCC patients with extrahepatic metastasis and intrahepatic lesion, and that alternative treatments should be considered for these patients after sorafenib treatment.