Adjuvant sorafenib after RFA boosts survival in recurrent hepatocellular carcinoma

The use of sorafenib as an adjuvant therapy after radiofrequency ablation (RFA) appears to improve survival outcomes in patients with recurrent hepatocellular carcinoma (HCC) who underwent hepatectomy, according to a study.

Researchers reviewed the medical records of 460 patients with recurrent HCC within Milan criteria from four institutions across China. Of the patients, 85 received RFA plus sorafenib (RFA–sorafenib group) while 275 patients received RFA only (RFA group). A total of 254 tumours in the former and 371 tumours in the latter groups were ablated.

After propensity-score matching (PSM), a total of 174 patients in each group were included in the analysis. The median follow-up was 62.0 months in the combination group and 60.9 months in the RFA group, with the median duration of sorafenib being 14.8 months.

Compared with those in the RFA group, patients in the RFA–sorafenib group were more likely to be men (78.4 percent vs 66.9 percent), experience early recurrence (69.2 percent vs 56.4 percent), have Barcelona clinic liver cancer (BCLC) B stage (39.5 percent vs 30.2 percent), and exhibit microvascular invasion (MVI; 46.5 percent vs 33.8 percent). However, these differences disappeared after PSM.

The RFA–sorafenib group had significantly better overall survival (OS) than the RFA group, with the respective 1-, 3-, and 5-year OS rates being 97.7 percent vs 93.1 percent, 83.7 percent vs 61.3 percent, and 54.7 percent vs 30.9 percent (p<0.001).

The tumour-free survival was also more favourable in the combination group, with the corresponding 1-, 3-, and 5-year TFS rates of 90.8 percent vs 67.8 percent, 49.0 percent vs 28.0 percent, and 20.4 percent vs 14.5 percent (p<0.001).

Subgroup analyses revealed that patients with a high risk score (based on factors including alpha-fetoprotein levels, tumour number, recurrent stage, primary tumour size, BCLC stage, and MVI) were more likely to benefit from RFA–sorafenib treatment.