Piñero Federico, Anders Margarita, Bermudez Carla, Arufe Diego, Varón Adriana, Palazzo Ana, Rodriguez Jorge, Beltrán Oscar, Simian Daniela, da Fonseca Leonardo Gomes, Ridruejo Ezequiel, Tamagnone Norberto, Cheinquer Hugo, Bejarano Diana, Marín Juan Ignacio, Orozco Federico, Pages Josefina, Poniachik Jaime, Marciano Sebastián, Reggiardo Virginia, Silva Marcelo, Mendizabal Manuel
Hospital Universitario Austral, Pilar, Argentina.
Hospital Alemán, Buenos Aires, Argentina.
Liver Int. 2025 May;45(5):e70092. doi: 10.1111/liv.70092.
The survival outcomes associated with hepatic recompensation in patients with advanced hepatocellular carcinoma (HCC) treated with first-line systemic therapies remain unclear. We compared survival from the initiation of first-line systemic treatments for advanced HCC among patients with compensated, decompensated, and recompensated cirrhosis.
A Latin American multicenter, prospective cohort study was conducted from 2018 to 2024, involving patients with HCC and Child-Pugh class A or B who received systemic therapy. At the time of first-line therapy, patients with cirrhosis were categorised as compensated (never decompensated), decompensated, or recompensated. Cox proportional hazards models were estimated.
Among 306 patients receiving first-line systemic therapy (sorafenib: 60.5%, atezolizumab + bevacizumab: 29.7%, lenvatinib: 9.1%), 240 had cirrhosis, with 30.4% having a history of hepatic decompensation. Of these, 57.5% (95% CI 45.4%-69.0%) achieved hepatic recompensation over a median period of 12 months. At the time of first-line therapy, 69.6% were compensated, 17.5% recompensated, and 12.9% decompensated. Metabolic-associated steatotic liver disease (MASLD) was the most common underlying aetiology in the recompensated group. Median survival was significantly shorter in the decompensated group (8.6 months) compared to the compensated group (17.2 months) [aHR 1.91 (95% CI 1.04-3.5); p = 0.03], without a significant difference between the recompensated and compensated groups [aHR 1.28 (95% CI 0.79-2.1); p = 0.31]. Tumour progression was the primary reason for treatment discontinuation, and similar access to second-line therapies was observed between the compensated and recompensated groups.
Patients with cirrhosis and advanced HCC who achieved hepatic recompensation might benefit from systemic therapies after a cautious observation period.
一线全身治疗的晚期肝细胞癌（HCC）患者肝脏代偿相关的生存结局仍不明确。我们比较了代偿期、失代偿期和再代偿期肝硬化的晚期HCC患者一线全身治疗开始后的生存期。
2018年至2024年进行了一项拉丁美洲多中心前瞻性队列研究，纳入接受全身治疗的HCC和Child-Pugh A或B级患者。在一线治疗时，肝硬化患者被分类为代偿期（从未失代偿）、失代偿期或再代偿期。估计Cox比例风险模型。
在306例接受一线全身治疗的患者中（索拉非尼：60.5%，阿替利珠单抗+贝伐单抗：29.7%，仑伐替尼：9.1%），240例有肝硬化，30.4%有肝失代偿史。其中，57.5%（95%CI 45.4%-69.0%）在中位12个月期间实现了肝脏再代偿。在一线治疗时，69.6%为代偿期，17.5%为再代偿期，12.9%为失代偿期。代谢相关脂肪性肝病（MASLD）是再代偿组最常见的潜在病因。失代偿组的中位生存期（8.6个月）明显短于代偿组（17.2个月）[调整后风险比1.91（95%CI 1.04-3.5）；p=0.03]，再代偿组和代偿组之间无显著差异[调整后风险比1.28（95%CI 0.79-2.1）；p=0.31]。肿瘤进展是治疗中断的主要原因，代偿组和再代偿组二线治疗的可及性相似。
实现肝脏再代偿的肝硬化和晚期HCC患者在谨慎观察期后可能从全身治疗中获益。
