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Master Thesis

Efficacité de la chimio embolisation dans le carcinome hépatocellulaire avancé (BCLC C)

Abstract : Introduction: transarterial chemoembolization (TACE) is the most frequently used first hepatocellular carcinoma (HCC) treatment in the world. However, sorafenib has been established as the standard of care for patients with advanced-stage HCC (BCLC stage C) since 2008, without randomized studies comparing TACE to sorafenib. More than two thirds of patients with advanced HCC die of intrahepatic tumor progression. Thus, a radical treatment strategy targeting the primary tumor in the liver is still debated. The aim of our study was to compare the efficacy of TACE versus sorafenib in advanced-stage HCC patients (BCLC C). Methods: a total of 298 patients with HCC first-treated with TACE or sorafenib, with hepatic veinous thrombosis and/or extrahepatic disease and/or a tumor-related impaired performance status (PS 1 or 2) was included. Patients were matched for main prognostic variables using a propensity score analysis. The primary outcome of interest was the overall survival. Results: after propensity score matching, the two groups of 99 patients had comparable liver function and intrahepatic tumor burden. The median overall survival in the TACE group (11,83 months) was significantly better than in the sorafenib group (6,13 months), with a hazard ratio of 0,71 (p=0,023). The independent prognostic factors were a baseline AFP≥400ng/ml, CRP≥50mg/l, tumor size, PS 2 and baseline ALBI score 2. Progression-free survival was not significantly different between the two groups. There was a more marked worsening of the ALBI score in the TACE group, but more than half of these patients had access to a second-line treatment. Conclusion: TACE appears to be an effective option in advanced HCC, the therapeutic strategy of which is currently undergoing changes. The challenge would be to identify criteria for choosing between first-line locoregional treatment and systemic therapy from the outset.
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Submitted on : Thursday, October 22, 2020 - 10:24:18 AM
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  • HAL Id : dumas-02974817, version 1



Bérénice Teulières. Efficacité de la chimio embolisation dans le carcinome hépatocellulaire avancé (BCLC C). Sciences du Vivant [q-bio]. 2020. ⟨dumas-02974817⟩



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