Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Liver Int. 2024 May;44(5):1108-1125. doi: 10.1111/liv.15885. Epub 2024 Mar 22.
Overweight is a negative prognostic factor in the general population in the long term. However, the role of body mass index (BMI) in the short-mid term in advanced tumours is unclear. The present analysis investigates the role of BMI weight classes in a large sample of patients affected by HCC and receiving atezolizumab plus bevacizumab or lenvatinib as first-line treatment.
The cohort included consecutive patients affected by BCLC-c and BCLC-B HCC patients from a multicenter international study group who received atezolizumab plus bevacizumab or lenvatinib as first-line therapy. Population was stratified according to the BMI in under-, over- and normal-weight according to the conventional thresholds. The primary objective of the study was to evaluate the prognostic and predictive impact of BMI in patients affected by advanced or intermediate HCC. Survival curves were estimated using the product-limit method of Kaplan-Meier. The role of stratification factors was analysed with log-rank tests.
1292 consecutive patients with HCC were analysed. 466 (36%) patients were treated with lenvatinib and 826 (64%) patients were treated with atezolizumab plus bevacizumab. In the atezolizumab plus bevacizumab arm, 510 (62%) patients were normal-weight, 52 (6%) underweight and 264 (32%) overweight. At the univariate analysis for OS, underweight patients had significantly shorter OS compared to normal-weight patients, whereas no differences were found between normal-weight versus overweight. Multivariate analysis confirmed that underweight patients had significantly shorter OS compared to normal-weight patients (HR: 1.7; 95% CI: 1.0-2.8; p = .0323). In the lenvatinib arm, 26 patients (5.6%) were categorized as underweight, 256 (54.9%) as normal-weight, and 184 (39.5%) as overweight. At the univariate analysis for OS, no significant differences were found between normal-weight versus underweight and between normal-weight versus overweight, which was confirmed at multivariate analysis.
Our analysis highlighted a prognostic role of BMI in a cohort of patients with advanced HCC who received atezolizumab plus bevacizumab, while no prognostic role for low BMI was apparent in patients who received lenvatinib.
超重是一般人群中长期的负面预后因素。然而，在晚期肿瘤中，体重指数（BMI）在短期至中期的作用尚不清楚。本分析调查了在接受阿替利珠单抗联合贝伐珠单抗或仑伐替尼作为一线治疗的大量 HCC 患者中，BMI 体重类别在患者中的作用。
该队列包括来自一个多中心国际研究小组的连续患者，这些患者患有 BCLC-c 和 BCLC-B HCC，并接受阿替利珠单抗联合贝伐珠单抗或仑伐替尼作为一线治疗。人群根据传统阈值分为超重、正常体重和低体重。本研究的主要目的是评估 BMI 在晚期或中期 HCC 患者中的预后和预测作用。使用 Kaplan-Meier 的乘积限法估计生存曲线。使用对数秩检验分析分层因素的作用。
分析了 1292 例连续 HCC 患者。466 例（36%）患者接受仑伐替尼治疗，826 例（64%）患者接受阿替利珠单抗联合贝伐珠单抗治疗。在阿替利珠单抗联合贝伐珠单抗组中，510 例（62%）患者为正常体重，52 例（6%）为低体重，264 例（32%）为超重。在 OS 的单因素分析中，低体重患者的 OS 明显短于正常体重患者，而正常体重与超重患者之间无差异。多因素分析证实，与正常体重患者相比，低体重患者的 OS 明显缩短（HR：1.7；95%CI：1.0-2.8；p=0.0323）。在仑伐替尼组中，26 例（5.6%）患者被归类为低体重，256 例（54.9%）为正常体重，184 例（39.5%）为超重。在 OS 的单因素分析中，正常体重与低体重以及正常体重与超重之间无显著差异，多因素分析也证实了这一点。
我们的分析强调了 BMI 在接受阿替利珠单抗联合贝伐珠单抗治疗的晚期 HCC 患者队列中的预后作用，而在接受仑伐替尼治疗的患者中，低 BMI 似乎没有预后作用。
