The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing

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dc.contributor.authorKöstek, Osman
dc.contributor.authorDemirel, Ahmet
dc.contributor.authorHacıoğlu, Muhammet Bekir
dc.contributor.authorTaştekin, Didem
dc.contributor.authorKarabulut, Senem
dc.contributor.authorGündogdu, Abidin
dc.contributor.authorSever, Nadiye
dc.contributor.authorKaplan, Muhammet Ali
dc.contributor.orcid0000-0002-1901-5603
dc.contributor.orcid0000-0003-0882-0524
dc.date.accessioned2024-04-24T17:56:17Z
dc.date.available2024-04-24T17:56:17Z
dc.date.issued2024
dc.departmentDicle Üniversitesi, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, İç Hastalıklar Ana Bilim Dalıen_US
dc.description.abstractThe prognosis of patients with advanced HCC can vary widely depending on factors such as the stage of the cancer, the patient’s overall health, and treatment regimens. This study aimed to investigate survival outcomes and associated factors in patients with hepatocellular carcinoma (HCC). In this retrospective study, data from 23 medical oncology clinics were analyzed. Progression-free survival (PFS) and overall survival (OS) values were estimated using the Kaplan–Meier method. Prognostic factors associated with survival which were identified in univariate analysis were subsequently evaluated in a multivariate Cox-regression survival analysis was conducted using the backward stepwise (Conditional LR) method to determine the independent predictors of PFS and OS. Of 280 patients, 131 received chemotherapy and 142 received sorafenib, 6 received atezolizumab plus bevacizumab and 1 received nivolumab for first-line setting. The median follow-up time was 30.4 (95%CI 27.1–33.6) months. For-first line, median PFS was 3.1 (95%CI2.7–3.5) months, and it was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab (PFS 5.8 (95%CI 4.2–7.5) than in those received chemotherapy (PFS 2.1 (95%CI 1.9–2.3) in the first-line setting (p < 0.001). Multivariate analysis revealed that male gender (HR: 2.75, 95% CI: 1.53–4.94, p = 0.01), poor ECOG performance score (HR: 1.88, 95% CI: 1.10–3.21, p = 0.02), higher baseline AFP level (HR: 2.38, 95% CI: 1.54–3.67, p < 0.001) and upfront sorafenib treatment (HR,0.38; 95% CI: 0.23–0.62, p < 0.001) were significantly associated with shorter PFS. The median OS was 13.2 (95%CI 11.1–15.2) months. It was significantly longer in patients who received sorafenib or atezolizumab-bevacizumab or nivolumab in the first-line setting followed by TKIs (sorafenib or regorafenib, OS 18.6 (95%CI 13.8–23.5)) compared to those who received chemotherapy (OS 10.3 (95%CI 6.6–14.1)) in the first-line setting. The multivariate analysis revealed that upfront chemotherapy treatment approach, male gender (HR: 1.77, 95% CI: 1.07–2.94, p = 0.02), poor ECOG performance score (HR: 1.96, 95% CI: 1.24–3.09, p = 0.004) and Child-Pugh score, presence of extrahepatic disease (HR: 1.54, 95% CI: 1.09–2.18, p = 0.01), and higher baseline AFP value (HR: 1.50, 95% CI: 1.03–2.19, p = 0.03) were significantly associated with poor prognosis. Additionally, regarding of treatment sequence, upfront sorafenib followed by regorafenib showed a significantly lower risk of mortality (HR: 0.40, 95% CI: 0.25–0.66, p < 0.001). Sorafenib followed by regorafenib treatment was associated with a significantly lower risk of mortality rather than upfront sorafenib followed by BSC group or upfront chemotherapy followed by TKIs. These findings underscore the importance of the optimal treatment sequences to improve survival in patients with advanced HCC.en_US
dc.identifier.citationKöstek, O., Demirel, A., Hacıoğlu, M. B., Taştekin, D., Karabulut, S., Gündoğdu, A. ve diğerleri. (2024). The prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing. Journal of Chemotherapy, 1-9.
dc.identifier.doi10.1080/1120009X.2024.2305066
dc.identifier.issn1120-009X
dc.identifier.scopus2-s2.0-85182995661
dc.identifier.scopusqualityQ3
dc.identifier.urihttps://doi.org/10.1080/1120009X.2024.2305066
dc.identifier.urihttps://hdl.handle.net/11468/23425
dc.identifier.urihttps://www.tandfonline.com/doi/full/10.1080/1120009X.2024.2305066
dc.indekslendigikaynakScopus
dc.language.isoenen_US
dc.publisherTaylor and Francis Ltd.en_US
dc.relation.ispartofJournal of Chemotherapy
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectChemotherapyen_US
dc.subjectHccen_US
dc.subjectProtein kinase inhibitorsen_US
dc.subjectTreatment sequenceen_US
dc.titleThe prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencingen_US
dc.titleThe prognostic factors in patients with advanced hepatocellular carcinoma: impact of treatment sequencing
dc.typeArticleen_US

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