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Wada et al. Hepatoma Research 2018;4:8 Hepatoma Research
DOI: 10.20517/2394-5079.2017.39

Original Article Open Access

Prediction of post-progression survival in patients
with advanced hepatocellular carcinoma treated
with sorafenib by using time-dependent changes in
clinical characteristics

Yoshiyuki Wada, Yuko Takami, Hajime Matsushima, Masaki Tateishi, Tomoki Ryu, Munehiro Yoshitomi,
Hideki Saitsu

Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center,
Fukuoka 810-8563, Japan.

Correspondence to: Dr. Yoshiyuki Wada, Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National
Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. E-mail: yoshiwada@kyumed.jp

How to cite this article: Wada Y, Takami Y, Matsushima H, Tateishi M, Ryu T, Yoshitomi M, Saitsu H. Prediction of post-progression
survival in patients with advanced hepatocellular carcinoma treated with sorafenib by using time-dependent changes in clinical
characteristics. Hepatoma Res 2018;4:8. http://dx.doi.org/10.20517/2394-5079.2017.39

Received: 1 Sep 2017 First Decision: 20 Sep 2017 Revised: 19 Feb 2018 Accepted: 24 Feb 2018 Published: 6 Mar 2018

Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Aim: Sorafenib has been shown to improve time to tumor progression (TTP) and overall survival (OS) in patients
with hepatocellular carcinoma (HCC); however, post-progression survival (PPS) has not been well characterized in
these patients. This study aimed to evaluate the predictors of PPS by using time-dependent and dynamic changes
in radiologic progression patterns, liver function, and performance status (PS) in patients with advanced HCC
receiving sorafenib treatment.

Methods: We retrospectively analyzed the clinical characteristics of 128 advanced HCC patients with Child-Pugh
scores ≤ 7 at the initiation of sorafenib treatment.

Results: The median TTP, OS, and PPS were 3.8, 15.6, and 9.9 months, respectively. At the time of confirmation of
radiologic progressive disease (PD), a total of 46 (35.6%) patients showed impairments in their PS of ≥ +1 points
over time. For the Child-Pugh score, 27 (21.1%) and 26 (10.9%) patients exhibited an impairment of ≥ +1 and ≥ +2
points, respectively. Multivariate analysis identified the following independent predictors of PPS: impairment in the
PS score of ≥ +1 point [hazard ratio (HR) 1.81, 95% confidence interval (CI) 1.16-2.82], impairment in the Child-
Pugh score of ≥ +2 points (HR 3.70, 95% CI 1.68-8.15), radiologic pattern of progression (target lesion growth and
emergence of a new lesion) (HR 2.91, 95% CI 1.79-2.91), a TTP < 4 months (HR 1.87, 95% CI 1.21-2.91), second-line
treatment after radiologic confirmation of PD (HR 0.16, 95% CI 0.08-0.32), and continuous sorafenib treatment
after radiologic confirmation of PD (HR 1.76, 95% CI 1.06-3.00).

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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