Abstract：
BACKGROUND: Atezolizumab plus bevacizumab is the standard of care for advanced hepatocellular carcinoma (HCC) in the first-line setting, although was only evaluated in patients with Child-Pugh (CP) A liver function in the IMbrave150 trial. We sought to determine the outcomes of these patients based on CP score and ALBI grade in the US population.
METHODS: This multicenter cohort study included patients with HCC who received atezolizumab with bevacizumab as first-line systemic therapy between March 2018 and November 2023. Overall survival (OS) was determined using the Kaplan-Meier method and multivariate analyses were performed using Cox proportional hazard regression method.
RESULTS: Among 322 patients, 226, 86, and 10 patients had CP-A, CP-B, and CP-C liver function, respectively. Median age was 66.5 years, 78.6% were male, and 82.6% were White. Median OS (mOS) was 21.6 months for those with CP-A, 9.1 months for those with CP-B7, and 4.7 months for those with CP-B8-C12 (P < .0001). Among patients with CP-A, those with ALBI grade 1 had an mOS of 34.9 months versus 14.2 months in those with grade 2. In multivariate analyses, CP score, ALBI grade, hepatitis B, performance status, and macrovascular invasion were significantly associated with survival.
CONCLUSIONS: CP score is an important prognostic tool for patients with HCC receiving atezolizumab plus bevacizumab, and this regimen remains a viable option for patients with CP-B7 with no additional safety concern, although the benefit is significantly less than those with CP-A. ALBI score has independent predictive value in patients with CP-A liver function.
METHODS: This multicenter cohort study included patients with HCC who received atezolizumab with bevacizumab as first-line systemic therapy between March 2018 and November 2023. Overall survival (OS) was determined using the Kaplan-Meier method and multivariate analyses were performed using Cox proportional hazard regression method.
RESULTS: Among 322 patients, 226, 86, and 10 patients had CP-A, CP-B, and CP-C liver function, respectively. Median age was 66.5 years, 78.6% were male, and 82.6% were White. Median OS (mOS) was 21.6 months for those with CP-A, 9.1 months for those with CP-B7, and 4.7 months for those with CP-B8-C12 (P < .0001). Among patients with CP-A, those with ALBI grade 1 had an mOS of 34.9 months versus 14.2 months in those with grade 2. In multivariate analyses, CP score, ALBI grade, hepatitis B, performance status, and macrovascular invasion were significantly associated with survival.
CONCLUSIONS: CP score is an important prognostic tool for patients with HCC receiving atezolizumab plus bevacizumab, and this regimen remains a viable option for patients with CP-B7 with no additional safety concern, although the benefit is significantly less than those with CP-A. ALBI score has independent predictive value in patients with CP-A liver function.
摘要：
背景：阿替珠单抗联合贝伐单抗是一线治疗晚期肝细胞癌（HCC）的标准治疗方法，尽管在IMbrave150试验中仅对Child-Pugh（CP）A肝功能患者进行了评估。我们试图根据美国人群的CP评分和ALBI等级来确定这些患者的结局。
方法：这项多中心队列研究包括在2018年3月至2023年11月期间接受阿特珠单抗联合贝伐单抗作为一线全身治疗的HCC患者。使用Kaplan-Meier方法确定总生存期（OS），并使用Cox比例风险回归方法进行多变量分析。
结果：在322名患者中，226、86和10例患者患有CP-A，CP-B,和CP-C肝功能，分别。中位年龄为66.5岁，78.6%为男性,82.6%是白人。CP-A患者的中位OS（mOS）为21.6个月，CP-B7患者为9.1个月，CP-B8-C12患者为4.7个月（P<0.0001）。在CP-A患者中，ALBI1级患者的mOS为34.9个月,2级患者的mOS为14.2个月.在多变量分析中，CP评分,ALBI等级,乙型肝炎，性能状态，大血管侵犯与生存率显著相关。
结论：CP评分是肝癌患者接受阿特珠单抗联合贝伐单抗治疗的重要预后工具，对于CP-B7患者，该方案仍然是一个可行的选择，没有额外的安全问题，尽管收益明显低于CP-A。ALBI评分对CP-A患者肝功能具有独立预测价值。
方法：这项多中心队列研究包括在2018年3月至2023年11月期间接受阿特珠单抗联合贝伐单抗作为一线全身治疗的HCC患者。使用Kaplan-Meier方法确定总生存期（OS），并使用Cox比例风险回归方法进行多变量分析。
结果：在322名患者中，226、86和10例患者患有CP-A，CP-B,和CP-C肝功能，分别。中位年龄为66.5岁，78.6%为男性,82.6%是白人。CP-A患者的中位OS（mOS）为21.6个月，CP-B7患者为9.1个月，CP-B8-C12患者为4.7个月（P<0.0001）。在CP-A患者中，ALBI1级患者的mOS为34.9个月,2级患者的mOS为14.2个月.在多变量分析中，CP评分,ALBI等级,乙型肝炎，性能状态，大血管侵犯与生存率显著相关。
结论：CP评分是肝癌患者接受阿特珠单抗联合贝伐单抗治疗的重要预后工具，对于CP-B7患者，该方案仍然是一个可行的选择，没有额外的安全问题，尽管收益明显低于CP-A。ALBI评分对CP-A患者肝功能具有独立预测价值。
