Please use this identifier to cite or link to this item: https://hdl.handle.net/11499/56724
Title: The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing
Authors: Köstek, O.
Demirel, A.
Hacıoğlu, M.B.
Tastekin, D.
Karabulut, S.
Gündogdu, A.
Sever, N.
Ayhan, Murat
Çelebi, Abdussamed
Majidova, Nargiz
Yaşar, Alper
Ağyol, Yeşim
Erel, Pınar
Kocaaslan, Erkam
Güren, Ali Kaan
Arıkan, Rukiye
Isık, Selver
Ercelep, Ozlem
Goksu, Sema Sezgin
Alandag, Celal
Bilgetekin, İrem
Caner, Burcu
Sahin, Ahmet Bilge
Gulmez, Ahmet
Akagunduz, Baran
Kose, Fatih
Kaplan, Muhammet Ali
Dogan, Ender
Sakalar, Teoman
Guven, Deniz Can
Gurbuz, Mustafa
Ergun, Yakup
Karaagac, Mustafa
Turker, Sema
Ozkul, Ozlem
Yıldız, Birol
Sahin, Süleyman
Demiray, Atike Gokcen
Sari, Murat
Erdogan, Bülent
Hacıbekiroglu, İlhan
Çakmak Öksüzoğlu, Ömür Berna
Kilickap, Saadettin
Bilici, Ahmet
Bayoglu, İbrahim Vedat
Topaloglu, Sernaz
Cicin, İrfan
Keywords: chemotherapy
HCC
protein kinase inhibitors
treatment sequence
Publisher: Taylor and Francis Ltd.
Abstract: The prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient’s overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan–Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1–33.6) months. For-first line, median PFS was 3.1 (95%CI2.7–3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2–7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9–2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53–4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10–3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54–3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23–0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1–15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8–23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6–14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07–2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24–3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09–2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03–2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25–0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC. © 2024 Edizioni Scientifiche per l'Informazione su Farmaci e Terapia (Italian Society of Chemotherapy).
URI: https://doi.org/10.1080/1120009X.2024.2305066
https://hdl.handle.net/11499/56724
ISSN: 1120-009X
Appears in Collections:Scopus İndeksli Yayınlar Koleksiyonu / Scopus Indexed Publications Collection
Tıp Fakültesi Koleksiyonu

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