Hiraoka Atsushi, Kumada Takashi, Tada Toshifumi, Hirooka Masashi, Kariyama Kazuya, Tani Joji, Atsukawa Masanori, Takaguchi Koichi, Itobayashi Ei, Fukunishi Shinya, Tsuji Kunihiko, Ishikawa Toru, Tajiri Kazuto, Ochi Hironori, Yasuda Satoshi, Toyoda Hidenori, Ogawa Chikara, Nishimura Takashi, Hatanaka Takeshi, Kakizaki Satoru, Shimada Noritomo, Kawata Kazuhito, Naganuma Atsushi, Kaibori Masaki, Tanaka Takaaki, Ohama Hideko, Nouso Kazuhiro, Morishita Asahiro, Tsutsui Akemi, Nagano Takuya, Itokawa Norio, Okubo Tomomi, Arai Taeang, Imai Michitaka, Koizumi Yohei, Nakamura Shinichiro, Joko Kouji, Iijima Hiroko, Kosaka Hisashi, Hiasa Yoichi, Kudo Masatoshi
Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
Liver Cancer. 2022 Dec 8;12(3):209-217. doi: 10.1159/000527402. eCollection 2023 Aug.
BACKGROUND/AIM: There is no known report regarding the relationship of atezolizumab plus bevacizumab (Atez/Bev) treatment with muscle volume loss (MVL) in unresectable hepatocellular carcinoma (u-HCC) patients. This study aimed to elucidate the clinical relationship between MVL and Atez/Bev.
MATERIALS/METHODS: From September 2020 to December 2021, 229 u-HCC patients treated with Atez/Bev and with muscle volume data obtained by computed tomography at the baseline available were analyzed (median age, 74 years; males, 186 (81.2%); ECOG PS 0/1, 221 (96.5%); HCV:HBV:alcohol:others = 81:33:40:75; Child-Pugh A, 212 (92.6%); modified albumin-bilirubin (mALBI) grade 1:2a:2b = 79:60:90; BCLC 0:A:B:C = 1:24:87:117; median observation period, 6.8 months). Japan Society of Hepatology criteria were used for definition of MVL and prognostic factors were retrospectively evaluated.
Multivariate Cox-hazard analysis of prognostic factors for progression-free survival (PFS) showed elevated alpha-fetoprotein (AFP) (≥100 ng/mL) (HR 1.848, 95% CI 1.264-2.702, = 0.002), mALBI grade (≥2a) (HR 1.563, 95% CI 1.035-2.359, = 0.034), and MVL (HR 1.479, 95% CI 1.020-2.144, = 0.039) as significant factors. For overall survival (OS), significant factors included elevated AFP (≥100 ng/mL) (HR 3.564, 95% CI 1.856-6.844, < 0.001), mALBI grade (≥2a) (HR 3.451, 95% CI 1.580-7.538, = 0.002), and MVL (HR 2.119, 95% CI 1.150-3.904, = 0.016). Patients with MVL (MVL group, = 91) showed worse PFS than those without (non-MVL group, = 138) (median PFS 5.3 vs. 7.6 months, = 0.025), while the MVL group showed worse OS ( = 0.038), though neither reached the median survival time.
MVL may be a clinical factor related to poor prognosis in patients receiving Atez/Bev treatment for u-HCC.
背景/目的：目前尚无关于阿替利珠单抗联合贝伐单抗（阿替利珠单抗/贝伐单抗）治疗与不可切除肝细胞癌（u-HCC）患者肌肉量减少（MVL）之间关系的报道。本研究旨在阐明MVL与阿替利珠单抗/贝伐单抗之间的临床关系。
材料/方法：对2020年9月至2021年12月期间接受阿替利珠单抗/贝伐单抗治疗且基线时有通过计算机断层扫描获得的肌肉量数据的229例u-HCC患者进行分析（中位年龄74岁；男性186例（81.2%）；东部肿瘤协作组体能状态0/1分，221例（96.5%）；丙型肝炎病毒：乙型肝炎病毒：酒精：其他=81:33:40:75；Child-Pugh A级，212例（92.6%）；改良白蛋白-胆红素（mALBI）分级1:2a:2b=79:60:90；巴塞罗那临床肝癌（BCLC）0:A:B:C级=1:24:87:117；中位观察期6.8个月）。采用日本肝脏学会标准定义MVL，并对预后因素进行回顾性评估。
无进展生存期（PFS）预后因素的多因素Cox风险分析显示，甲胎蛋白（AFP）升高（≥100 ng/mL）（风险比[HR]1.848，95%置信区间[CI]1.264-2.702，P=0.002）、mALBI分级（≥2a）（HR 1.563，95%CI 1.035-2.359，P=0.034）和MVL（HR 1.479，95%CI 1.020-2.144，P=0.039）为显著因素。对于总生存期（OS），显著因素包括AFP升高（≥100 ng/mL）（HR 3.564，95%CI 1.856-6.844，P<0.001）、mALBI分级（≥2a）（HR 3.451，95%CI 1.580-7.538，P=0.002）和MVL（HR 2.119，95%CI 1.150-3.904，P=0.016）。有MVL的患者（MVL组，n=91）的PFS比无MVL的患者（非MVL组，n=138）更差（中位PFS 5.3个月对7.6个月，P=0.025），而MVL组的OS更差（P=0.038），尽管两组均未达到中位生存时间。
MVL可能是接受阿替利珠单抗/贝伐单抗治疗的u-HCC患者预后不良的临床相关因素。
