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Hung et al. Attenuation of liver stiffness by sorafenib

validity of transient elastography. An IQR/median were expressed as the median for each patient. For
ratio of less than 0.3 is considered to indicate a the overall values, the values of SWV measurements
homogeneous set of measurements. [23,24] were expressed as the mean ± standard deviation. A
paired t-test was performed for a paired comparison
Non-invasive serologic indexes: AAR, APRI, of variables before and 3-6 months after treatment
FIB-4 index, and Lok index with sorafenib, including SWV measurements and
The non-invasive serologic index values at the non-invasive serologic indices. A P value < 0.05
beginning of sorafenib treatment and 3 months was considered to indicate a significant difference.
post-treatment were compared. The aspartate Statistical analysis was performed using the Statistical
aminotransferase (AST) to alanine aminotransferase Package for the Social Sciences (version 19.0, IBM
(ALT) ratio (AAR), the AST to platelet ratio index SPSS Statistics, New York, USA).
(APRI), the fibrosis-4 index (FIB-4), and the Lok index
for the non-invasive assessment of liver fibrosis were RESULTS
examined at 3 months interval. [25-28] The variables of The baseline clinical characteristics of the 17 patients
AST, ALT, international normalized ratio and platelets with advanced HCC are shown in Table 1. The mean
were recorded at the time of ARFI elastography. age was 59.7 ± 10.2 years, and 14 (82.4%) patients
were males. Ten (58.8%) patients had chronic hepatitis
Treatment response of HCC B infection, 5 (29.4%) patients had chronic hepatitis C
The treatment response of HCC to sorafenib was infection and 10 (58.8%) patients had liver cirrhosis. The
assessed based on the modified response evaluation mean duration of sorafenib treatment was 11.1 months,
criteria in solid tumors every 3-6 months after and the mean survival time was 15.1 months (range:
sorafenib administration and the treatment protocol 8.3-19.1 months; 95% confidence interval: 13.3-
was continued if the treatment response was disease 17.0 months) [Table 1].
control, including complete response (CR), partial
response (PR), and stable disease (SD). [29] Four The clinical characteristics of the case series are
types of response are defined as: (1) CR, which shown in Table 2. Two patients achieved CR, 1
indicates the disappearance of any intratumoral patient achieved PR, 6 patients experienced SD
arterial enhancement in all target lesions; (2) PR, and 8 patients experienced PD after a mean of 2.5
which indicates a decrease of at least 30% in the cycles of sorafenib treatment (range 1-4 cycles). The
sum of the diameters of viable (enhancement in the disease control rate, including CR, PR, and SD in the
arterial phase) target lesions, taking as a reference first 2 cycles was 52.9%. A 64-year-old male patient
the baseline sum of the diameters of the target (No. 11) suffered from recurrence of mesentery HCC
lesions; (3) SD, which includes any cases that do not after the initial surgical resection and achieved a CR
after 4 months of sorafenib treatment. A 34-year-old
qualify for either PR or progressive disease (PD); and female patient (No. 12) experienced lung metastases 6
(4) PD, which indicates an increase of at least 20% weeks after partial hepatectomy. She had a complete
in the sum of the diameters of viable (enhancing)
target lesions, taking as reference the smallest sum Table 1: Baseline clinical characteristics
of the diameters of viable (enhancing) target lesions
recorded since treatment started. All patients have Characteristics Data
regular assessment every 2 or 3 months as 1 cycle Patient No. 17
and sorafenib administration was discontinued if Age, years 59.7 ± 10.2
the treatment response of PD was identified by liver Male, % 14 (82.4)
Liver cirrhosis, %
10 (58.8)
CT assessment or if the patient’s clinical condition HBV/HCV/none 10/5/2
deteriorated. All patients survived in the observation Albumin, g/dL 4.1 ± 0.4
peroid; 1 lost to follow-up in 1 year; and the others AST, U/L 56.2 ± 37.3
were disease free or shifted to second line treatment. ALT, U/L 44.6 ± 24.5
We used Common Terminology Criteria for Adverse Bilirubin, mg/dL 0.8 ± 0.3
1.13 ± 0.08
Events (CTCAE) version 4.0 for adverse events INR 3 6,288.0 ± 2,198.0
Leukocytes, 10 /L
severity evaluation and there was no grade IV adverse Hemoglobin, mg/dL 13.5 ± 1.7
event in this study. Platelets, 10 /L 171.5 ± 57.2
9
Duration of sorafenib, months 8.5 ± 3.9
Statistical analysis Survival time, months 11.1 ± 4.0
Clinical data were evaluated with descriptive statistics. HBV: hepatitis B virus; HCV: hepatitis C virus; AST: aspartate
transaminase; ALT: alanine transaminase; INR: international
The SWV measurements of the liver parenchyma normalized ratio
54 Hepatoma Research ¦ Volume 3 ¦ March 24, 2017