Gut Liver.  2017 Sep;11(5):693-701. 10.5009/gnl16391.

Survival Estimates after Stopping Sorafenib in Patients with Hepatocellular Carcinoma: NEXT Score Development and Validation

• Lee HW
• Kim HS
• Kim SU
• Kim DY
• Kim BK
• Park JY
• Ahn SH
• Jeon MY
• Heo JY
• Park SY
• Lee YR
• Jang SK
• Lee SH
• Jang SY
• Tak WY
• Han KH

• KMID: 2389358
• DOI: http://doi.org/10.5009/gnl16391

Abstract

BACKGROUND/AIMS
Limited information is available regarding patient survival after sorafenib discontinuation in patients with hepatocellular carcinoma (HCC). Thus, we developed and validated a novel survival prediction model.
METHODS
Clinical data from 409 patients with HCC who stopped taking sorafenib between September 2008 and February 2015 were reviewed.
RESULTS
In the training cohort, four factors were independent negative predictors of survival (p<0.05). Based on the β regression coefficient of each factor, we established the NEXT score (Survival after Stopping Nexavar Treatment), allocating 1 point each for an Eastern Cooperative Oncology Group score ≥2, Child-Pugh class B or C, serum sodium ≤135 mEq/L, and α-fetoprotein >400 ng/mL. Area under the receiver operating characteristic curve values to predict 1-, 3-, and 6-month survival rates were 0.805, 0.809, and 0.774, respectively, in the training cohort and 0.783, 0.728, and 0.673, respectively, in the validation cohort (n=137). When the training and validation cohorts were stratified into three risk groups (NEXT score 0 [low-risk] vs 1 to 2 [intermediate-risk] vs 3 to 4 [high-risk]), survival differed significantly between the groups (p<0.05, log-rank test).
CONCLUSIONS
In patients with HCC, survival after stopping sorafenib is poor. However, risk estimates based on a new "NEXT score" may help predict survival and prognosis even in patients who discontinue sorafenib treatment.

Keyword

Hepatocellular carcinoma; Survival; Sorafenib; Prediction; Risk

MeSH Terms

Carcinoma, Hepatocellular*
Cohort Studies
Humans
Prognosis
ROC Curve
Sodium
Survival Rate
Sodium