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available. [2] criteria also included Eastern Cooperative Oncology
Group Performance Status of 0 or 1; Child-Pugh
Sorafenib is a multikinase inhibitor which inhibits liver function class A. All eligible patients received
angiogenesis by targeting the vascular endothelial continuous oral treatment with 400 mg of sorafenib
growth factor (VEGF) receptor 2 and platelet-derived (consisting of two 200-mg tablets, provided by Bayer
growth factor receptor pathway and blocks cell HealthCare Pharmaceuticals) twice daily. HCC is
proliferation by targeting the Ras/mitogen-activated staged according to the Barcelona Clinic Liver Cancer
protein kinase signaling pathway. Two global phase (BCLC) classification. HCCs were divided into good
[11]
III trials (SHARP and Asia-Pacific trial) showed arterial supply and poor arterial supply according
[4]
[3]
that sorafenib prolonged the survival of patients to the enhancement intensity on CT scan or MRI
with advanced HCC. Following that, multiple studies and were assessed by an experienced radiologist
have been conducted to determine the predictor for who was blind to clinical information. Good arterial
survival in patients treated with sorafenib. There are supply is defined as enhancement in ≥ 60% lesions
some previous reports concerning the relationship while poor arterial supply is defined as enhancement
between prognosis of patients treated with sorafenib in ≤ 40% lesions.
and parameters of computed tomography (CT) scan
and magnetic resonance imaging (MRI). [5-8] Hahn Study design
et al. showed that the area under the contrast Our null hypothesis was that patients with a good
[6]
concentration vs. time curve 90 s after contrast arterial supply of tumors and those with a poor
injection (IAUC90) and volume transfer constant arterial supply of tumors benefitted similar outcomes.
of contrast agent [K (trans)] measured by MRI The primary endpoint of the trial was the 12-month
were prognostic pharmacodynamic biomarkers for overall survival (OS) rate. The secondary end points
metastatic renal carcinoma treated with sorafenib. In were the recurrence-free survival rate and the overall
[7]
addition, Hsu et al. found K (trans) correlated well recurrence rate. Data were collected and stored in
with tumor response and survival in HCC patients the liver cancer database management system by a
who received sorafenib plus metronomic tegafur/ designated clinical study center assistant chosen by
uracil therapy. Sorafenib signif icantly suppressed the Research Ethics Committee.
tumor per fusion, tumor vascularity, and endothelial
permeability-surface area product quantif ied by CT This study met the requirements of the Declaration
scan in experimental prostate carcinoma in rats. [5,9,10] of Helsinki and was approved by the Research Ethics
It seems that CT scan or MRI may be applicable Committee of the Eastern Hepatobiliary Surgery
for imaging biomarkers of therapy response to Hospital, which is affiliated with the Second Military
antiangiogenic therapy. Medical University. Informed consent was obtained
from all recruited patients.
We present our monocentric experience with
sorafenib in the treatment of HCC patients and will Follow-up
attempt to identify predictive factors for survival, by Clinical examinations were performed for each
placing emphasis on the correlation of the results patient, with laboratory assessment (routine tests
from imaging and survival. of liver and kidney function and AFP) every month
and imaging exams (chest X-ray and abdominal CT
METHODS scan or MRI) every other month. A systemic nuclide
scan was carried out when metastasis was suspected.
Patients Additional treatments, such as transarterial
A total of 38 HCC patients treated from April 2009 chemoembolization (TACE), were applied when
to December 2010 with sorafenib were included in necessary. Adverse events were under sur veillance,
this study. Hypervascular HCCs were diagnosed by and proper managements were provided when
at least 2 radiologic imaging showing characteristic necessary.
features of HCC (contrast enhancement on the arterial
phase with venous washout), or 1 radiologic imaging Statistical analysis
showing characteristic features of HCC associated Quantitative data were expressed as a mean ±
with alpha-fetoprotein (AFP) ≥ 400 ng/mL, while standard deviation (SD) or median (range) where
hypovascular HCCs were diagnosed by biopsy with appropriate and compared using the independent
cytological or histological confirmation. Eligibility sample t-test. For quantitative data, the gaussianity

88 Hepatoma Research | Volume 2 | April 1, 2016