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Radioembolization versus sorafenib in locally advanced HCC with PVTT: A Propensity Score and Bayesian analysis.

BACKGROUND & AIMS
Sorafenib is the recommended treatment for patients with advanced hepatocellular carcinoma (HCC). However, radioembolization (TARE) of HCC provides encouraging results both in terms of survival and capability to rescue unresectable tumors to surgery. This study evaluates the outcome reached with TARE and sorafenib in patients with HCC and intra-hepatic portal vein tumor thrombosis (PVTT).


METHODS
A total of 65 patients with HCC and intra-hepatic PVTT treated in five Italian hospitals between 2012 and 2018 were included in the analysis. Exclusion criteria were any previous treatment, extension of PVTT to the main portal tract and extrahepatic involvement. Propensity score and Bayesian analysis were performed.


RESULTS
Forty-one patients were treated with TARE and 24 with sorafenib. Eleven patients were rescued to curative-intent surgery (3 liver transplant and 8 hepatectomy), 10 with TARE and 1 with sorafenib; TARE was significantly more effective than sorafenib in downstaging patients to surgery providing a mean survival of 54 months. In the 54 patients without downstaging after treatment, 31 treated with TARE and 23 with sorafenib, median survival was 20 months and 9 months respectively (p = 0.001), with different 1, 2- and 3- years OS rates (64%, 43% and 37% vs 39%, 13% and 0%). Both propensity score and Bayesian model averaging confirmed an improvement in overall survival in TARE group compared to sorafenib treatment.


CONCLUSIONS
TARE was more effective than sorafenib in downstaging patients to surgery providing a significant improvement in survival. Even in patients who were not rescued to surgery, survival appeared to be superior with TARE. This article is protected by copyright. All rights reserved.