Relationship between ethnicity and overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib (S).
Journal Articles
Overview
Research
Identity
Additional Document Info
View All
Overview
abstract
248 Background: The SHARP and Asia Pacific (AP) trials showed that S improves OS compared to placebo in advanced HCC. However, OS was worse in the AP trial which included predominantly Asian patients. It is unclear if ethnicity, or perhaps Hepatitis B (HBV) infection, is a poor prognostic factor for these patients. The purpose of this study was to determine whether ethnicity affects OS in patients with advanced HCC being treated with S. Methods: All patients treated with S for HCC in Alberta, Canada from 01/2008 to 07/2016 were included. Patient demographics and clinical/pathological variables were retrospectively collected. Patients were dichotomized by ethnicity as either East Asian or not according to a validated list of surnames. Survival outcomes were assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox-proportional hazard model was constructed with ethnicity and relevant clinical/pathological characteristics to assess their impact on survival. Results: A total of 175 patients were included. Mean age was 64 years. 78% were men, 28% were East Asian, and 79% were Child-Pugh A at initiation of S. The most common etiologies of underlying liver disease were Hepatitis C (HCV) (31%), HBV (29%) and alcohol (21%). 42% had distant metastatic disease. The majority of patients had an ECOG performance status of 0 (26%) or 1 (64%). Median OS was 9.0 months in Asians and 9.5 months in non-Asians (p = 0.68). On multivariate analysis, ethnicity (HR 0.76, 95% CI 0.39 – 1.32, p = 0.33) was not a significant prognostic factor for OS. However, lack of distant metastases (HR 0.57 95% CI 0.40 - 0.82, p < 0.01), initial AFP < 400 (HR 0.54 95%CI 0.38 - 0.78, p < 0.01) and 3+ localized treatments (HR 0.60 95% CI 0.39 - 0.92, p = 0.02) were associated with better OS. Further, HBV was associated with inferior OS when compared to HCV (HR 2.12, 95% CI 1.08 - 4.17, p = 0.03). Conclusions: When treated with S in one Canadian province, ethnicity does not appear to be a prognostic factor for OS. However, HCV infection, lack of distant metastases, initial AFP < 400, and 3+ previous localized treatments were significant prognosticators of OS. We are validating these findings in a larger multi-centre Canadian dataset.
