METHODS: A prospective cohort of 200 HCC patients treated with AtezoBev was studied alongside a retrospective cohort of 123 patients treated with Sorafenib. We assessed factors influencing progression-free survival (PFS), overall survival (OS), AVB and clinical ascites development, focusing on PHT parameters, and comparing outcomes within and between the two cohorts (time-dependent Cox model and adjusted survival curves).
RESULTS: Among the AtezoBev cohort, 10% experienced AVB, 24% had high-risk esophageal varices (EV) and 46% vascular invasion. Median PFS and OS in the AtezoBev cohort was 5.13 and 12.2 months. AVB (HR=1.81;[95%CI:1.03-3.17]) and clinical ascites occurrence (HR=2.29;[95%CI:1.52-3.45]) were independently associated with mortality. AVB incidence was 12% at 12 months in AtezoBev patients and EV, history of AVB<6months and vascular invasion were independently associated with AVB. The Sorafenib cohort had shorter median PFS and OS, with similar AVB incidence and only EV were associated with AVB.
CONCLUSIONS: PHT-related events significantly affect not only liver decompensation but also OS in AtezoBev-treated patients. We suggest a more widespread use of NSBB to prevent liver decompensation, with intensified prophylaxis for high-risk patients.
方法:对200例接受AtezoBev治疗的HCC患者进行前瞻性队列研究,同时对123例接受索拉非尼治疗的患者进行回顾性队列研究。我们评估了影响无进展生存期(PFS)的因素,总生存期(OS),AVB和临床腹水发展,专注于PHT参数,并比较两个队列内部和之间的结局(时间依赖性Cox模型和调整后的生存曲线)。
结果:在AtezoBev队列中,10%有AVB经验,24%有高危食管静脉曲张(EV)和46%的血管侵犯。AtezoBev队列的PFS和OS中位数分别为5.13和12.2个月。AVB(HR=1.81;[95CI:1.03-3.17])和临床腹水发生率(HR=2.29;[95CI:1.52-3.45])与死亡率独立相关。AtezoBev患者在12个月时AVB发生率为12%,AVB病史<6个月和血管侵犯与AVB独立相关.索拉非尼队列的中位PFS和OS较短,AVB的发生率相似,只有EV与AVB相关。
结论:PHT相关事件不仅显著影响AtezoBev治疗患者的肝脏失代偿,也影响OS。我们建议更广泛地使用NSBB来预防肝脏失代偿,加强对高危患者的预防。