https://orcid.org/0000-0003-3055-8817
To the Editor,
We read with great interest the article by Dr. Liu et al. [Citation1]. This retrospective study compared the benefits of sorafenib with microwave ablation (MWA) in intermediate-stage hepatocellular carcinoma (HCC) patients with tumor size ≤7 cm and tumor number ≤5 after transcatheter arterial chemoembolization (TACE) failure. Moreover, The author used propensity score matching (PSM) analysis on two different treatment methods and pointed out that MWA was superior to sorafenib in improving survival for intermediate-stage HCC patients with tumor size ≤7 cm and tumor number ≤5 after TACE failure.
First, we congratulate the authors on the perfect match in this study. Seven variables were included in the PSM analysis, and eight patients were excluded from the MWA group. However, the precision of the PSM analysis was not mentioned.
Second, tumor number, tumor size, and a-fetoprotein level were all regarded as matching variables in the whole cohort. While it is noteworthy that, in the subgroup analysis for patients with solitary HCC ≤ 3 cm and for patients with multiple tumors, patients were selected from the cohort after the PSM analysis. Patients should have been selected from the whole cohort according to the subgroup criteria before the PSM analysis. The variables of tumor number, tumor size, and a-fetoprotein level should have been excluded when matching. The results obtained by this method are more convincing.
Third, the method of administration of sorafenib may lead to different outcomes. Several approaches have been tested for the timing of sorafenib initiation: (1) sequential administration [Citation2], (2) the interrupted administration [Citation3,Citation4] and (3) the continuous administration [Citation5]. Therefore, the lack of a detailed description of the method of administration with sorafenib in this article may lead to biased results. In addition, HCC in advanced stage requires a comprehensive management strategy. The article mainly collects survival data to evaluate the outcome between sorafenib and MWA. Due to the lack of analysis of treatment complications, the conclusions and results may be misjudged.
In conclusion, we appreciate the authors’ efforts in exploration of the treatment of intermediate-Stage HCC. However, we suggest that appropriate modification and improvement in statistical analysis would further confirm and greatly solidify the conclusions of the study.
Disclosure statement
No potential conflict of interest was reported by the author(s).
References
- Chen S, Shi M, Shen L, et al. Microwave ablation versus sorafenib for intermediate-stage hepatocellular carcinoma with transcatheter arterial chemoembolization refractoriness: a propensity score matching analysis. Int J Hyperthermia. 2020;37:384–391.
- Park JW, Koh YH, Kim HB, et al. Phase II study of concurrent transarterial chemoembolization and sorafenib in patients with unresectable hepatocellular carcinoma. J Hepatol. 2012;56:1336–1342.
- Lencioni R, Llovet JM, Han G, et al. Sorafenib or placebo plus TACE with doxorubicin-eluting beads for intermediate stage HCC: the SPACE trial. J Hepatol. 2016;64:1090–1098.
- Meyer T, Fox R, Ma YT, et al. Sorafenib in combination with transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma (TACE 2): a randomised placebo-controlled, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol. 2017;2:565–575.
- Strebel BM, Dufour JF. Combined approach to hepatocellular carcinoma: a new treatment concept for nonresectable disease. Expert Rev Anticancer Ther. 2008;8:1743–1749.