Suzuki Takanori, Matsuura Kentaro, Kato Daisuke, Hayashi Katsumi, Okayama Kohei, Okumura Fumihiro, Sobue Satoshi, Kusakabe Atsunori, Hasegawa Izumi, Narita Kiyoto, Mizoshita Tsutomu, Kimura Yoshihide, Sato Ryo, Kondo Hiromu, Ozasa Atsushi, Kawamura Hayato, Fujiwara Kei, Nojiri Shunsuke, Kataoka Hiromi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Gastroenterology, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
Oncology. 2025 May 26:1-10. doi: 10.1159/000546515.
Atezolizumab plus bevacizumab (ATZ + BV) is used for the treatment of Barcelona Clinic Liver Cancer (BCLC) stage B unresectable hepatocellular carcinoma (u-HCC) patients. However, the efficacy of ATZ + BV in various BCLC stage B conditions, especially the up-to-seven criteria in/out, has not been fully investigated.
We enrolled 83 BCLC stage B u-HCC patients with Child-Pugh class A who were treated with ATZ + BV as the first-line systemic chemotherapy in the study. All patients were evaluated for initial responses by dynamic computed tomography or magnetic resonance imaging after the initiation of ATZ + BV, and therapeutic efficacy was assessed.
When stratified by up-to-seven criteria, progression-free survival (PFS) was significantly prolonged in patients with up-to-seven in (in vs. out: median 21.0 vs. 8.2 months, p = 0.006), and the Cox proportional hazard model showed that up-to-seven out/in was the significant factor contributing to PFS (out vs. in: HR 2.58, p = 0.007). We next evaluated PFS stratified by the maximum intrahepatic tumor diameter and number of intrahepatic tumors, which constitute the up-to-seven criteria. The number of tumors was a significant factor contributing to PFS (>7 vs. ≤7: HR 1.75, p = 0.040), but maximum tumor size was not (>5 cm vs. ≤5 cm: HR 1.19, p = 0.588).
In BCLC stage B u-HCC patients treated with ATZ + BV, a high number of intrahepatic tumors were associated with poor PFS. Therefore, it may be better to consider additional treatment strategies in these patients.
阿替利珠单抗联合贝伐单抗（ATZ + BV）用于治疗巴塞罗那临床肝癌（BCLC）B期不可切除肝细胞癌（u-HCC）患者。然而，ATZ + BV在各种BCLC B期情况下的疗效，尤其是七项标准内/外情况，尚未得到充分研究。
我们纳入了83例Child-Pugh A级的BCLC B期u-HCC患者，在本研究中接受ATZ + BV作为一线全身化疗。所有患者在开始ATZ + BV治疗后通过动态计算机断层扫描或磁共振成像评估初始反应，并评估治疗效果。
根据七项标准分层时，七项标准内的患者无进展生存期（PFS）显著延长（内与外：中位数21.0个月对8.2个月，p = 0.006），Cox比例风险模型显示七项标准外/内是影响PFS的显著因素（外与内：HR 2.58，p = 0.007）。接下来，我们评估了根据构成七项标准的最大肝内肿瘤直径和肝内肿瘤数量分层的PFS。肿瘤数量是影响PFS的显著因素（>7个与≤7个：HR 1.75，p = 0.040），但最大肿瘤大小不是（>5 cm与≤5 cm：HR 1.19，p = 0.588）。
在接受ATZ + BV治疗的BCLC B期u-HCC患者中，肝内肿瘤数量多与PFS较差相关。因此，在这些患者中考虑额外的治疗策略可能更好。
