Ohara Masatsugu, Suda Goki, Kohya Risako, Yasui Yutaka, Tsuchiya Kaoru, Kurosaki Masayuki, Tani Joji, Maekawa Shinya, Enomoto Nobuyuki, Chuma Makoto, Morimoto Manabu, Kaneko Shun, Nakagawa Mina, Asahina Yasuhiro, Komori Atsumasa, Kugiyama Yuki, Baba Masaru, Nakamura Akihisa, Ito Jun, Yamada Ren, Hosoda Shunichi, Yamamoto Yoshiya, Yoshida Sonoe, Sho Takuya, Sasaki Takashi, Yoda Tomoka, Meno Akimitsu, Yasuura Naohiro, Fu Qingjie, Yang Zijian, Maehara Osamu, Ohnishi Shunsuke, Tokuchi Yoshimasa, Kitagataya Takashi, Kawagishi Naoki, Nakai Masato, Ogawa Koji, Sakamoto Naoya
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
Department of Gastroenterology, Hepatology Musashino Red Cross Hospital, Tokyo, Japan.
Hepatol Int. 2025 Aug 28. doi: 10.1007/s12072-025-10875-7.
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality. Although the atezolizumab/bevacizumab regimen demonstrated impressive efficacy in the IMbrave150 clinical trial, long-term outcomes, particularly 3-year overall survival (OS), remain unestablished because of limited follow-up. Long-term outcomes have been reported for the tremelimumab/durvalumab combination, highlighting the need for comparable data on atezolizumab/bevacizumab. We aimed to elucidate the 3-year OS in patients with unresectable HCC (uHCC) treated with atezolizumab plus bevacizumab.
This retrospective multicenter study included patients with uHCC who received atezolizumab/bevacizumab. Among the 506 patients treated at the participating institutions, only those who initiated therapy between October 2020 and January 2022 were included. Comprehensive clinical, laboratory, and imaging data were collected, and the patients were followed up until March 2025.
A total of 257 patients were analyzed, with a median follow-up of 48.23 months (range, 36.23-53.60 months). The 2- and 3-year OS rates were 39.2% and 25.3%, respectively. Among patients meeting the IMbrave150 criteria, the 3-year OS rate was 31.6%. Multivariate regression analysis identified baseline alpha-fetoprotein level > 116 ng/mL (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.20-0.84; p = 0.015) and modified albumin-bilirubin grade 1-2a (OR 2.50; 95% CI 1.18-5.32; p = 0.017) as significant factors associated with 3-year OS.
In a real-world setting, the 3-year OS for uHCC patients treated with atezolizumab/bevacizumab was 25.3%, rising to 31.6% among those meeting the IMbrave150 criteria. Survival outcomes underscore the clinical value of atezolizumab/bevacizumab in improving long-term prognosis and guiding first-line treatment decisions for patients with unresectable HCC.
肝细胞癌（HCC）仍然是癌症相关死亡的主要原因。尽管阿替利珠单抗/贝伐珠单抗方案在IMbrave150临床试验中显示出令人瞩目的疗效，但由于随访有限，长期预后，尤其是3年总生存期（OS）仍未明确。已报道了曲美木单抗/度伐利尤单抗联合方案的长期预后，这凸显了获取阿替利珠单抗/贝伐珠单抗可比数据的必要性。我们旨在阐明接受阿替利珠单抗联合贝伐珠单抗治疗的不可切除HCC（uHCC）患者的3年总生存期。
这项回顾性多中心研究纳入了接受阿替利珠单抗/贝伐珠单抗治疗的uHCC患者。在参与机构接受治疗的506例患者中，仅纳入了那些在2020年10月至2022年1月之间开始治疗的患者。收集了全面的临床、实验室和影像学数据，并对患者进行随访直至2025年3月。
共分析了257例患者，中位随访时间为48.23个月（范围36.23 - 53.60个月）。2年和3年总生存率分别为39.2%和25.3%。在符合IMbrave150标准的患者中，3年总生存率为31.6%。多因素回归分析确定基线甲胎蛋白水平>116 ng/mL（比值比[OR] 0.41；95%置信区间[CI] 0.20 - 0.84；p = 0.015）和改良白蛋白 - 胆红素分级1 - 2a（OR 2.50；95% CI 1.18 - 5.32；p = 0.017）是与3年总生存期相关的重要因素。
在真实世界中，接受阿替利珠单抗/贝伐珠单抗治疗的uHCC患者的3年总生存率为25.3%，在符合IMbrave150标准的患者中升至31.6%。生存结果强调了阿替利珠单抗/贝伐珠单抗在改善不可切除HCC患者长期预后和指导一线治疗决策方面的临床价值。
