PDF(Pubmed)
Abstract：
UNASSIGNED: Despite the emergence of atezolizumab and bevacizumab (A + B) as standard first-line systemic therapy for unresectable hepatocellular carcinoma (HCC), a comprehensive understanding of the clinical significance of immune-related adverse events (irAEs) remains limited. We aimed to assess the impact of irAEs on patients with HCC undergoing A + B treatment.
UNASSIGNED: This multicentre retrospective study included consecutive patients with HCC who were treated with the A + B regimen from September 2020 to December 2022. Patients were categorized into three groups based on the severity of irAEs, ranging from those without any experience of irAEs to those with severe irAEs.
UNASSIGNED: This study included 150 patients with HCC, with a mean age of 63.3 years. Among them, 93.3% of patients were classified as Barcelona Clinic Liver Cancer stage C, 52.0% had portal vein tumour thrombosis (PVTT), and 60.7% extrahepatic spread. Patients were classified as follows: group 1 (n = 84) had no irAEs, group 2 (n = 37) had mild irAEs (grade 1-2), and group 3 (n = 29) had severe irAEs (grade ≥3). The median overall survival (OS), progression-free survival (PFS), and time-to-treatment discontinuation (TTD) were 13.6, 5.7, and 3.6 months, respectively. Group 2 demonstrated significantly superior OS compared to group 1 (9.5 months) and group 3 (5.6 months), with a median OS of 23.0 months (p < 0.001). Furthermore, group 2 demonstrated significantly better outcomes in terms of PFS and TTD compared to both group 1 and group 3 (p < 0.001 for both). Multivariate analysis identified mild irAEs (hazard ratio [HR], 0.353; p = 0.010), ALBI grade 1 (HR, 0.389; p = 0.006), Child-Pugh class A (HR, 0.338; p = 0.002), and the absence of PVTT (HR, 0.556; p = 0.043) as independent predictors of better OS.
UNASSIGNED: Our study highlights the significant impact of irAE severity on the outcomes of patients with HCC receiving A + B. Notably, the occurrence of mild irAEs was independently associated with favourable survival, suggesting their potential role as surrogate indicators of HCC prognosis.
UNASSIGNED: This multicentre retrospective study included consecutive patients with HCC who were treated with the A + B regimen from September 2020 to December 2022. Patients were categorized into three groups based on the severity of irAEs, ranging from those without any experience of irAEs to those with severe irAEs.
UNASSIGNED: This study included 150 patients with HCC, with a mean age of 63.3 years. Among them, 93.3% of patients were classified as Barcelona Clinic Liver Cancer stage C, 52.0% had portal vein tumour thrombosis (PVTT), and 60.7% extrahepatic spread. Patients were classified as follows: group 1 (n = 84) had no irAEs, group 2 (n = 37) had mild irAEs (grade 1-2), and group 3 (n = 29) had severe irAEs (grade ≥3). The median overall survival (OS), progression-free survival (PFS), and time-to-treatment discontinuation (TTD) were 13.6, 5.7, and 3.6 months, respectively. Group 2 demonstrated significantly superior OS compared to group 1 (9.5 months) and group 3 (5.6 months), with a median OS of 23.0 months (p < 0.001). Furthermore, group 2 demonstrated significantly better outcomes in terms of PFS and TTD compared to both group 1 and group 3 (p < 0.001 for both). Multivariate analysis identified mild irAEs (hazard ratio [HR], 0.353; p = 0.010), ALBI grade 1 (HR, 0.389; p = 0.006), Child-Pugh class A (HR, 0.338; p = 0.002), and the absence of PVTT (HR, 0.556; p = 0.043) as independent predictors of better OS.
UNASSIGNED: Our study highlights the significant impact of irAE severity on the outcomes of patients with HCC receiving A + B. Notably, the occurrence of mild irAEs was independently associated with favourable survival, suggesting their potential role as surrogate indicators of HCC prognosis.
摘要：
■尽管阿特珠单抗和贝伐单抗（A+B）作为不可切除的肝细胞癌（HCC）的标准一线全身治疗的出现，对免疫相关不良事件(irAEs)临床意义的全面了解仍然有限.我们旨在评估irAE对接受A+B治疗的HCC患者的影响。
■这项多中心回顾性研究包括2020年9月至2022年12月接受A+B方案治疗的连续HCC患者。根据irAE的严重程度将患者分为三组，从那些没有任何历史经验的人到那些有严重历史的人。
■这项研究包括150例肝癌患者，平均年龄63.3岁.其中,93.3％的患者被归类为巴塞罗那临床肝癌C期，52.0%有门静脉肿瘤血栓形成(PVTT),和60.7%的肝外扩散。患者分类如下：第1组（n=84）没有irAE，第2组（n=37）有轻度irAE（1-2级），第3组（n=29）有严重的irAE（≥3级）。中位总生存期(OS)，无进展生存期（PFS），停药时间（TTD）分别为13.6、5.7和3.6个月，分别。与第1组（9.5个月）和第3组（5.6个月）相比，第2组表现出明显的OS，中位OS为23.0个月（p<0.001）。此外，与第1组和第3组相比，第2组的PFS和TTD结局明显更好（均p<0.001）。多变量分析确定了轻度IRAE(风险比[HR]，0.353;p=0.010),ALBI1级（HR，0.389；p=0.006），Child-Pugh类A(HR，0.338；p=0.002)，和不存在PVTT(HR，0.556；p=0.043)作为更好操作系统的独立预测因子。
■我们的研究强调了irAE严重程度对接受A+B的HCC患者预后的显著影响。轻度irAE的发生与良好的生存率独立相关，提示它们作为HCC预后替代指标的潜在作用。
■这项多中心回顾性研究包括2020年9月至2022年12月接受A+B方案治疗的连续HCC患者。根据irAE的严重程度将患者分为三组，从那些没有任何历史经验的人到那些有严重历史的人。
■这项研究包括150例肝癌患者，平均年龄63.3岁.其中,93.3％的患者被归类为巴塞罗那临床肝癌C期，52.0%有门静脉肿瘤血栓形成(PVTT),和60.7%的肝外扩散。患者分类如下：第1组（n=84）没有irAE，第2组（n=37）有轻度irAE（1-2级），第3组（n=29）有严重的irAE（≥3级）。中位总生存期(OS)，无进展生存期（PFS），停药时间（TTD）分别为13.6、5.7和3.6个月，分别。与第1组（9.5个月）和第3组（5.6个月）相比，第2组表现出明显的OS，中位OS为23.0个月（p<0.001）。此外，与第1组和第3组相比，第2组的PFS和TTD结局明显更好（均p<0.001）。多变量分析确定了轻度IRAE(风险比[HR]，0.353;p=0.010),ALBI1级（HR，0.389；p=0.006），Child-Pugh类A(HR，0.338；p=0.002)，和不存在PVTT(HR，0.556；p=0.043)作为更好操作系统的独立预测因子。
■我们的研究强调了irAE严重程度对接受A+B的HCC患者预后的显著影响。轻度irAE的发生与良好的生存率独立相关，提示它们作为HCC预后替代指标的潜在作用。
