Prolonged survival with 9 years of continuous use of sorafenib in unresectable hepatocellular carcinoma: a case report

Abstract

Background: Primary liver cancer ranks as the third leading cause of cancer-related mortality worldwide, with over 830.000 deaths reported in 2020. Hepatocellular carcinoma (HCC) constitutes approximately 75% of all primary malignant liver tumors. Although its overall survival benefit is considered modest, sorafenib continues to represent an important systemic therapeutic option approved for advanced HCC. This case report underscores the exceptional overall survival of nine years in a patient with multifocal HCC treated with sorafenib—an outcome considered highly uncommon within this clinical context. Case Presentation: In 2010, a 42-year-old male with a history of alcoholic liver cirrhosis was diagnosed with multifocal HCC (Child-Pugh class A, score 5; Barcelona Clinic Liver Cancer [BCLC] stage C) and referred to our institution. Sorafenib therapy was initiated. At diagnosis, serum alpha-fetoprotein (AFP) was 5 IU/mL. Throughout a 9-year treatment period, AFP levels gradually increased; however, the patient remained clinically stable and asymptomatic, significantly exceeding median survival expectations documented in the literature for similar cases. Conclusion: Although sorafenib provides only a modest improvement in overall survival, it was associated with an unexpectedly prolonged survival in the case described.