Treatment strategy of adding transcatheter arterial chemoembolization to sorafenib for advanced stage hepatocellular carcinoma

Background: Therapeutic effect and immunosuppressor cell alteration in adding transcatheter arterial chemoembolization (TACE) to sorafenib for advanced stage hepatocellular carcinoma (HCC) remain unclear. Aims: To examine the therapeutic effect and immunosuppressor cell alteration in adding TACE to sorafenib. Methods: Forty-four advanced stage HCC patients were divided into group A (n = 17) treated by sorafenib (400-600 mg/day) alone and group B patients (n = 27) treated by sorafenib and TACE. The frequency of regulatory T-cells and myeloid-derived suppressor cells (MDSC), and patients' outcomes were examined. Advanced HCC patients' survival was improved by adding TACE to sorafenib if N/L was reduced from ≥2.5 to <2.5 by TACE. Results: The median (interquartile) follow-up for all patients was 8.5 (3.5 to 15.5) with a range from 1 to 71 months. The median (interquartile) survival was 5.0 (2.3-11.3) months for group A and 11.0 (5.0-19.0) months for group B patients (P =.024). In group A, the patients (n = 8) with neutrophil-to-lymphocytes ratio (N/L) < 2.5 had better survival than the patients (n = 9) with N/L ≥ 2.5 (P =.006). In group B, 6 of 13 patients with N/L ≥ 2.5 had N/L reduction to <2.5 after combination therapy of sorafenib and TACE, and their 6-month, 1-year and 2-year survival were improved (P =.013). For immune cell examination, the frequency of CD4⁺ and CD8⁺ T-lymphocytes, regulatory T-cell and MDSC were not altered by sorafenib treatment. However, actual number of lymphocytes had a tendency to increase (from 978.5 ± 319.4/mm³ prior to treatment to 1378.0 ± 403.3/mm³, P =.086) for the patients with N/L reduction. Conclusion: Immunosuppressor cells were not altered by sorafeinb. Patients' survival was improved if N/L ≥ 2.5 was reduced to <2.5 by TACE.