Nagumo Hideki, Nagai Hidenari, Higai Koji, Matsuda Takahisa, Igarashi Yoshinori
Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota, Japan.
Department of Medical Biochemistry, Faculty of Pharmaceutical Sciences, Toho University, Ota, Japan.
Oncology. 2025;103(5):369-379. doi: 10.1159/000541674. Epub 2024 Oct 23.
Pharmacological treatment of unresectable hepatocellular carcinoma (uHCC) includes sorafenib and lenvatinib, a tyrosine kinase inhibitor, which are linked to low serum levels of carnitine and reduced skeletal muscle volume. Nowadays, atezolizumab plus bevacizumab (Atezo/Bev) combination therapy is recommended as the first-line treatment for patients with uHCC. However, the association with decreased muscle mass or cardiac function is unknown. Therefore, this study aimed to evaluate the effects of Atezo/Bev on skeletal muscle volume and cardiac function in patients with uHCC.
This retrospective study included 55 adult Japanese patients with chronic liver diseases and uHCC treated with Atezo/Bev. Patients were divided into three groups according to age: middle, preold, and old. Serum levels of carnitine and cardiac function were measured before and after 3 weeks of treatment. The psoas muscle index (PMI) was measured before and after 6 weeks of treatment.
After treatment, the global longitudinal strain was significantly lower in the old group, whereas the PMI and ejection fraction were significantly lower in the preold and old groups. However, no significant difference in serum levels of total carnitine and those fractions with treatment in each group was found. Cardiac function decreased in the preold and old groups.
When treating patients with uHCC by Atezo/Bev, caution should be taken in preold and old patients because they are vulnerable to decreased skeletal muscle mass and deterioration of cardiac function. Strength training and regular monitoring of cardiac function are encouraged in these groups.
不可切除肝细胞癌（uHCC）的药物治疗包括索拉非尼和酪氨酸激酶抑制剂乐伐替尼，这些药物与血清肉碱水平降低和骨骼肌体积减少有关。如今，阿替利珠单抗联合贝伐单抗（阿替利珠单抗/贝伐单抗）联合疗法被推荐为uHCC患者的一线治疗方案。然而，其与肌肉量减少或心脏功能下降之间的关联尚不清楚。因此，本研究旨在评估阿替利珠单抗/贝伐单抗对uHCC患者骨骼肌体积和心脏功能的影响。
这项回顾性研究纳入了55例接受阿替利珠单抗/贝伐单抗治疗的成年日本慢性肝病合并uHCC患者。根据年龄将患者分为三组：中年组、老年前期组和老年组。在治疗3周前后测量血清肉碱水平和心脏功能。在治疗6周前后测量腰大肌指数（PMI）。
治疗后，老年组的整体纵向应变显著降低，而老年前期组和老年组的PMI和射血分数显著降低。然而，每组治疗前后总肉碱水平及其各组分水平均未发现显著差异。老年前期组和老年组的心脏功能下降。
使用阿替利珠单抗/贝伐单抗治疗uHCC患者时，老年前期和老年患者应谨慎，因为他们易出现骨骼肌量减少和心脏功能恶化。建议这些组进行力量训练并定期监测心脏功能。
