Kaplan David E, Tan Ruoding, Xiang Cheryl, Mu Fan, Hernandez Sairy, Ogale Sarika, Li Jiayang, Lin Yilu, Shi Lizheng, Singal Amit G
Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA.
Cancers (Basel). 2024 Oct 17;16(20):3508. doi: 10.3390/cancers16203508.
This study evaluated comparative overall survival (OS) of United States veterans with unresectable hepatocellular carcinoma (uHCC) receiving first-line (1L) atezolizumab plus bevacizumab vs. sorafenib or lenvatinib, overall and across racial and ethnic groups. In this retrospective study, patients with uHCC who initiated atezolizumab plus bevacizumab (post-2020) or sorafenib or lenvatinib (post-2018) were identified from the Veterans Health Administration National Corporate Data Warehouse (1 January 2017-31 December 2022). Patient characteristics were evaluated in the year prior to 1L treatment initiation. Kaplan-Meier and multivariable Cox regression methods were used to compare OS starting from treatment between cohorts, both overall and by race and ethnicity. Among the 1874 patients included, 405 (21.6%) received 1L atezolizumab plus bevacizumab, 1016 (54.2%) received sorafenib, and 453 (24.2%) received lenvatinib, with a median follow-up time of 8.5, 7.6, and 8.2 months, respectively. Overall, patients receiving atezolizumab plus bevacizumab had longer unadjusted median OS (12.8 [95% CI: 10.6, 17.1] months) than patients receiving sorafenib (8.0 [7.1, 8.6] months) or lenvatinib (9.5 [7.8, 11.4] months; both log-rank < 0.001). After adjustment, atezolizumab plus bevacizumab was associated with a reduced risk of death by 30% vs. sorafenib (adjusted HR: 0.70 [95% CI: 0.60, 0.82]) and by 26% vs. lenvatinib (0.74 [0.62, 0.88]; both < 0.001). OS trends in the White, Black, and Hispanic patient cohorts were consistent with that of the overall population. Atezolizumab plus bevacizumab was associated with improved survival outcomes compared with sorafenib and lenvatinib in patients with uHCC, both overall and across racial and ethnic subgroups.
本研究评估了接受一线阿替利珠单抗联合贝伐单抗与索拉非尼或乐伐替尼治疗的美国不可切除肝细胞癌（uHCC）退伍军人的总体生存率（OS），涵盖总体人群以及不同种族和族裔群体。在这项回顾性研究中，从退伍军人健康管理局国家企业数据仓库（2017年1月1日至2022年12月31日）中识别出开始使用阿替利珠单抗联合贝伐单抗（2020年后）或索拉非尼或乐伐替尼（2018年后）治疗的uHCC患者。在开始一线治疗前一年评估患者特征。采用Kaplan-Meier法和多变量Cox回归方法比较各队列从治疗开始的总体生存率，以及按种族和族裔划分的生存率。纳入的1874例患者中，405例（21.6%）接受一线阿替利珠单抗联合贝伐单抗治疗，1016例（54.2%）接受索拉非尼治疗，453例（24.2%）接受乐伐替尼治疗，中位随访时间分别为8.5个月、7.6个月和8.2个月。总体而言，接受阿替利珠单抗联合贝伐单抗治疗的患者未调整的中位总生存期（12.8[95%CI：10.6，17.1]个月）长于接受索拉非尼治疗的患者（8.0[7.1，8.6]个月）或接受乐伐替尼治疗的患者（9.5[7.8，11.4]个月；对数秩检验均<0.001）。调整后，与索拉非尼相比，阿替利珠单抗联合贝伐单抗使死亡风险降低30%（调整后HR：0.70[95%CI：0.60，0.82]），与乐伐替尼相比降低26%（0.74[0.62，0.88]；均<0.001）。白种人、黑种人和西班牙裔患者队列的总生存期趋势与总体人群一致。在uHCC患者中，无论总体人群还是不同种族和族裔亚组，与索拉非尼和乐伐替尼相比，阿替利珠单抗联合贝伐单抗均与改善生存结局相关。
