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Lecchini et al. Hepatoma Res 2017;3:260-7 Hepatoma Research
DOI: 10.20517/2394-5079.2017.44
www.hrjournal.net
Original Article Open Access

Neoplastic macrovascular invasion

represents an independent risk factor for

dismal survival in sorafenib treatment for

hepatocellular carcinoma

Michele Lecchini , Andrea Olivani , Elisabetta Biasini , Raffaele Dalla Valle , Carlo Ferrari , Gabriele Missale ,
1
1
2
1
1
1
Claudia Schianchi 1
1 Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy.
2 Department of Surgery, University of Parma, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy.
Correspondence to: Dr. Gabriele Missale, Unit of Infectious Diseases and Hepatology, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14,
43126 Parma, Italy. E-mail: missale@tin.it
How to cite this article: Lecchini M, Olivani A, Biasini E, Dalla Valle R, Ferrari C, Missale G, Schianchi C. Neoplastic macrovascular invasion
represents an independent risk factor for dismal survival in sorafenib treatment for hepatocellular carcinoma. Hepatoma Res 2017;3:260-7.
ABSTRACT

Article history: Aim: Sorafenib efficacy and safety in advanced hepatocellular carcinoma (HCC) have been
Received: 16 Sep 2017 demonstrated in two randomized international clinical trials and in clinical practice studies.
First Decision: 20 Oct 2017 Because of poor survival advantage, to identify clinical and biological parameters remains an
Revised: 1 Nov 2017 unmet clinical need. Methods: Eighty-four patients treated with sorafenib were evaluated for
response to therapy and prognostic factors possibly associated with survival. Results: Median
Accepted: 2 Nov 2017 overall survival was 8.5 months. Median duration of therapy was 2.5 months with a median
Published: 16 Nov 2017
daily dose of 800 mg (IQR 600-800). Dose was adjusted in 52% of patients. Radiological
Key words: response to therapy showed a significant impact on survival. Child-Pugh score and neoplastic
Hepatocellular carcinoma, invasion of the portal system were negatively associated with survival. Continuation of
sorafenib, sorafenib even at lower dose was positively correlated with survival. The multivariate analysis
neoplastic portal vein thrombosis identified vascular invasion as the only independent variable: median survival of 5.5 months
for neoplastic portal vein thrombosis compared to 12 months in the remaining subjects.
Conclusion: A lower sorafenib daily dose is advantageous, even though the reason of this
association cannot be explained at present. Neoplastic portal vein thrombosis is strongly
associated with dismal survival. Alternative or complementary treatment approaches should
be studied in order to improve outcome in this subgroup of patients.

INTRODUCTION with over 570,000 people affected [1,2] . The incidence of
HCC is higher in Asia and Africa, where the endemic
Hepatocellular carcinoma (HCC) is a primary solid high prevalence of hepatitis B virus (HBV) and hepatitis
tumor of the liver and occurs predominantly in patients C virus (HCV) infections strongly predisposes to the
with underlying chronic liver disease and cirrhosis. It development of chronic liver disease and consequently
is the third leading cause of cancer deaths worldwide, HCC [3,4] . In developed countries there is the growing
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