Abstract：
BACKGROUND: Portal hypertension (PHT) often complicates hepatocellular carcinoma (HCC) treatment and prognosis. We aimed to assess PHT\'s impact on AtezoBev outcomes and identify predictors of acute variceal bleeding (AVB) and clinical ascites occurrence.
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.
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.
摘要：
背景：门静脉高压症（PHT）通常会使肝细胞癌（HCC）的治疗和预后复杂化。我们旨在评估PHT对AtezoBev结局的影响，并确定急性静脉曲张破裂出血（AVB）和临床腹水发生的预测因子。
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。
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。
