Relationship of Atezolizumab Plus Bevacizumab Treatment with Muscle Volume Loss in Unresectable Hepatocellular Carcinoma Patients: Multicenter Analysis

Background/aim: There is no known report regarding the relationship of atezolizumab plus bevacizumab (Atez/Bev) treatment with muscle volume loss (MVL) in unresectable hepatocellular carcinoma (u-HCC) patients. This study aimed to elucidate the clinical relationship between MVL and Atez/Bev.

Materials/methods: From September 2020 to December 2021, 229 u-HCC patients treated with Atez/Bev and with muscle volume data obtained by computed tomography at the baseline available were analyzed (median age, 74 years; males, 186 (81.2%); ECOG PS 0/1, 221 (96.5%); HCV:HBV:alcohol:others = 81:33:40:75; Child-Pugh A, 212 (92.6%); modified albumin-bilirubin (mALBI) grade 1:2a:2b = 79:60:90; BCLC 0:A:B:C = 1:24:87:117; median observation period, 6.8 months). Japan Society of Hepatology criteria were used for definition of MVL and prognostic factors were retrospectively evaluated.

Results: Multivariate Cox-hazard analysis of prognostic factors for progression-free survival (PFS) showed elevated alpha-fetoprotein (AFP) (≥100 ng/mL) (HR 1.848, 95% CI 1.264-2.702, = 0.002), mALBI grade (≥2a) (HR 1.563, 95% CI 1.035-2.359, = 0.034), and MVL (HR 1.479, 95% CI 1.020-2.144, = 0.039) as significant factors. For overall survival (OS), significant factors included elevated AFP (≥100 ng/mL) (HR 3.564, 95% CI 1.856-6.844, < 0.001), mALBI grade (≥2a) (HR 3.451, 95% CI 1.580-7.538, = 0.002), and MVL (HR 2.119, 95% CI 1.150-3.904, = 0.016). Patients with MVL (MVL group, = 91) showed worse PFS than those without (non-MVL group, = 138) (median PFS 5.3 vs. 7.6 months, = 0.025), while the MVL group showed worse OS ( = 0.038), though neither reached the median survival time.

Conclusion: MVL may be a clinical factor related to poor prognosis in patients receiving Atez/Bev treatment for u-HCC.

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