| Background: Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related death in the world.The number of HCC deaths(about 800,000 per year)overlaps the number of new cases,which proves its high mortality rate.In recent years,with the progress of diagnosis technology and the improvement of operation methods,the early diagnosis rate and resection rate of HCC have been improved,but the recurrence rate after resection is as high as 68%,and the long-term prognosis of patients is very poor.Sorafenib is the first target drug approved for clinical application,and can improve the progression time and total survival time of patients with advanced HCC.Fatigue is one of the most common adverse events(AE),which can lead to the adjustment of sorafenib dosage or even the interruption of treatment,but there are few reports about relationship between fatigue of sorafenib and prognosis of patients with advanced HCC.Research purposes: To explore the effect of fatigue on the survival of patients with advanced liver cancer treated with sorafenib.Research methods: The clinicopathological data and follow-up results of 182 patients with advanced liver cancer from October 1th,2008 to October 31,2018 were analyzed retrospectively.All patients were treated for at least 3 months oral sorafenib.According to NCI CTCAE version 5.0,patients were divided into three groups: fatigue level Ⅰ(n = 74),fatigue level Ⅱ(n = 62)and fatigue level Ⅲ(n = 46).Kaplan-Meier method(log-rank test)was used for survival analysis.The t test was used for continuous variables and chi square test was used for categorical variables.Results: This group included 163 males and 19 females with an average age of 56.0 years(35-81 years).147 cases had hepatitis B background and 3 cases had hepatitis C background.The history of HCC treatment included liver transplantation or hepatectomy in 93 cases,transcatheter arterial chemoembolization(TACE)in 64 cases,radiofrequency ablation in 13 cases,and medication in 12 cases after diagnosis.162 cases of Child-Pugh A and 20 cases of Child-Pugh B were treated.The results of survival analysis showed that the median time to progression time(m TTP)was 10.7 months(95% CI: 9.14-12.26 months),and the median overall survival time(m OS)was 19.5 months(95% CI: 16.48-22.53 months).The results of multivariate analysis showed that fatigue was one of the independent risk factors for the prognosis of sorafenib.Subgroup analysis showed that the m TTP time of level Ⅰ,level Ⅱ and level Ⅲ fatigue was 20.3 months,10.0 months and 6.2 months respectively,and the mOS time was 33.0 months,18.3 months and 10.1 months respectively.The m TTP time was 20.3 months in the fatigue relief group and 7.7 months in the fatigue non relief group(P < 0.001);the m OS time was 33.0 months in the fatigue relief group and 15.0 months in the fatigue non relief group(P < 0.001).Conclusion: Fatigue was one of the most common adverse drug reactions in patients with advanced HCC treated with sorafenib.The related fatigue adverse reactions were one of the independent risk factors affecting the prognosis of patients with advanced HCC with oral sorafenib.The patients could relieve drug-related fatigue got a better prognosis than patients not relieve the fatigue.Tumor overload was easily to lead to increased fatigue during oral sorafenib. |
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