Prognostic factors in patients with hepatocellular carcinoma treated with Sorafenib

Purpose: We aimed to identify prognostic factors for patients with hepatocellular carcinoma (HCC) treated with sorafenib and to evaluate the efficacy of sorafenib with respect to liver function. Patients and methods: In this retrospective study, 148 HCC patients received sorafenib 400mg bid in 11 Austrian institutions. Seventy-eight HCC patients treated with best supportive care (BSC) in the pre-sorafenib era served as control. Results: Child-Pugh (CP) stage A/B for HCC patients within Barcelona Clinic Liver Cancer (BCLC) stage B and C was n=76/55 for sorafenib and n=17/22 for BSC. Seventeen (sorafenib) and 39 (BSC) patients had end-stage (BCLC D) HCC. In sorafenib patients, low baseline α-Fetoprotein, low CP-stage, compensated cirrhosis, and low baseline aspartate aminotransferase (AST) were associated with a significantly longer overall survival (OS) on univariate analysis. CP-stage and baseline AST were independent prognostic factors on multivariate analysis. Within BCLC stage B and C, CPA-patients had a median OS of 11.3 (sorafenib) vs. 6.4 (BSC) months (p=0.010); for CPB-patients, median OS for sorafenib vs. BSC was 5.5 vs. 1.9 months (p=0.021). In end-stage HCC (BCLC D), no survival difference was observed between sorafenib and BSC patients (1.5 vs. 1.4 months; p=0.116). In the sorafenib group (BCLC B, C), the strongest discriminative power of AST for OS was observed in CPB-patients (AST <100 vs. ≥100U/l, 6.5 vs. 2.1 months; p=0.011). Conclusion: Sorafenib proglongs survival in HCC patients with CPA cirrhosis. In CPB-patients, baseline AST is the best parameter to select patients prior to initiation of sorafenib.