Clinical Benefit of Hepatic Arterial Infusion Concurrent Chemoradiotherapy in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis
Cancer Research and Treatment 2016³â 48±Ç 1È£ p.190 ~ p.197
À±È«ÀÎ(Yoon Hong-In) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
¼Û±âÁØ(Song Ki-Jun) - Yonsei University College of Medicine Department of Biostatics
ÀÌÀÍÀç(Lee Ik-Jae) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
±èµµ¿µ(Kim Do-Young) - Yonsei University College of Medicine Yonsei Liver Cancer Special Clinic
Çѱ¤Çù(Han Kwang-Hyub) - Yonsei University College of Medicine Yonsei Liver Cancer Special Clinic
¼ºÁø½Ç(Seong Jin-Sil) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
Abstract
Purpose : The aim of this study was to evaluate whether hepatic arterial infusion concurrent chemoradiotherapy (CCRT) could improve overall survival (OS) in patients with locally advanced hepatocellular carcinoma (LAHCC).
Materials and Methods : Two databases were reviewed from Yonsei Cancer Center (YCC) and Korean Liver Cancer Study Group (KLCSG) nationwide multi-center hepatocellular carcinoma (HCC) cohort. The CCRT group included 106 patients, with stage III-IV, Child-Pugh classification A, Eastern Cooperative Oncology Group performance status 0 or 1, who underwent definitive CCRT as the initial treatment at YCC. We used propensity score matching to adjust for seven clinical factors, including age, tumor size, TNM stage by the Liver Cancer Study Group of Japan, T stage, Barcelona Clinic Liver Cancer (BCLC) staging system, etiology of HCC, and portal vein invasion, which all differed significantly in the two databases. From the KLCSG cohort enrolled at 32 institutions, 106 patients for the non-CCRT group were defined.
Results : After propensity score matching, all patient characteristics were balanced between the two groups. The CCRT group had better OS (median, 11.4) than the non-CCRT group (6.6 months, p=0.02). In multivariate analyses for all patients, CCRT (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.11 to 1.97; p=0.007), tumor size (HR, 1.08; 95% CI, 1.04 to 1.12; p < 0.001), and BCLC stage (HR, 0.54; 95% CI, 0.36 to 0.8; p=0.003) were independent prognostic factors for OS.
Conclusion : CCRT showed better OS for LAHCC patients. In LAHCC patients with a good performance and normal liver function, CCRT could be a feasible treatment option. All of these findings need to be validated in prospective clinical trials.
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Hepatocellular carcinoma, Radiotherapy, Propensity score
KMID :
0939920160480010190
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CCRT group (median OS, 11.4 months; 5-year OS, 10.4%) had significantly better OS than the non-CCRT group (median OS, 6.6 months; 5-year OS, 8.5%; p=0.02).