Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cancer Res Treat. 2024 Oct;56(4):1219-1230. doi: 10.4143/crt.2024.283. Epub 2024 May 7.
This study aimed to identify clinical and radiologic characteristics that could predict response to atezolizumab-bevacizumab combination therapy in patients with advanced hepatocellular carcinoma (HCC).
This single-center retrospective study included 108 advanced HCC patients with intrahepatic lesions who were treated with atezolizumab-bevacizumab. Two radiologists independently analyzed imaging characteristics of the index tumor on pretreatment computed tomography. Predictive factors associated with progressive disease (PD) at the best response based on Response Evaluation Criteria in Solid Tumors, ver. 1.1 were evaluated using logistic regression analysis. Progression-free survival (PFS) was estimated by the Kaplan-Meier method and compared with the log-rank test.
Of 108 patients with a median PFS of 15 weeks, 40 (37.0%) had PD during treatment. Factors associated with PD included the presence of extrahepatic metastases (adjusted odds ratio [aOR], 4.13; 95% confidence interval [CI], 1.19 to 14.35; p=0.03), the infiltrative appearance of the tumor (aOR, 3.07; 95% CI, 1.05 to 8.93; p=0.04), and the absence of arterial-phase hyperenhancement (APHE) (aOR, 6.34; 95% CI, 2.18 to 18.47; p < 0.001). Patients with two or more of these factors had a PD of 66.7% and a median PFS of 8 weeks, indicating a significantly worse outcome compared to the patients with one or no of these factors.
In patients with advanced HCC treated with atezolizumab-bevacizumab treatment, the absence of APHE, infiltrative appearance of the intrahepatic tumor, and presence of extrahepatic metastases were associated with poor response and survival. Evaluation of early response may be necessary in patients with these factors.
本研究旨在确定能够预测晚期肝细胞癌（HCC）患者对阿替利珠单抗-贝伐珠单抗联合治疗反应的临床和影像学特征。
本单中心回顾性研究纳入了 108 例接受阿替利珠单抗-贝伐珠单抗治疗的肝内病变晚期 HCC 患者。两位放射科医生独立分析了治疗前 CT 上的肿瘤影像学特征。采用逻辑回归分析评估基于实体瘤反应评价标准 1.1 版（RECIST v1.1）最佳反应时进展疾病（PD）的预测因素。采用 Kaplan-Meier 法估计无进展生存期（PFS），并采用对数秩检验进行比较。
在中位 PFS 为 15 周的 108 例患者中，有 40 例（37.0%）在治疗期间发生 PD。与 PD 相关的因素包括肝外转移（调整后的优势比 [aOR]，4.13；95%置信区间 [CI]，1.19 至 14.35；p=0.03）、肿瘤浸润外观（aOR，3.07；95% CI，1.05 至 8.93；p=0.04）和动脉期增强（APHE）缺失（aOR，6.34；95% CI，2.18 至 18.47；p<0.001）。具有两个或更多这些因素的患者 PD 发生率为 66.7%，中位 PFS 为 8 周，与具有一个或没有这些因素的患者相比，预后明显更差。
在接受阿替利珠单抗-贝伐珠单抗治疗的晚期 HCC 患者中，APHE 缺失、肝内肿瘤浸润外观和肝外转移与不良反应和生存相关。对于具有这些因素的患者，可能需要评估早期反应。
