Atezolizumab Plus Bevacizumab Treatment for Patients With Hepatocellular Carcinoma in the Barcelona Clinic Liver Cancer B2 Stage
Keishi Ouchi, Masashi Ninomiya, Mio Tsuruoka, Jun Inoue, Atsushi Hiraoka, Kosuke Sato, Kotaro Doi, Kengo Watanabe, Tomoya Sasazaki, Takayoshi Oikawa, Kei Endo, Tamami Abe, Masashi Fujita, Kazumichi Abe, Tomohiro Katsumi, Wataru Sato, Chikara Iino, Nobukazu Tanabe, Hiroshi Numao, Hiromasa Ohira, Hidekatsu Kuroda, Yoshiyuki Ueno, Atsushi MasamuneABSTRACT
Background and Aim
The optimal treatment strategy for patients with intermediate‐stage hepatocellular carcinoma beyond the up‐to‐seven criteria (Barcelona Clinic Liver Cancer B2) remains uncertain. Although transarterial chemoembolization has long been the standard of care, its efficacy is limited in this subgroup, and systemic therapies have recently been introduced. We aimed to explore treatment modalities associated with survival beyond that predicted by a previously validated prognostic model.
Methods
We retrospectively analyzed 113 patients diagnosed with BCLC‐B2 stage hepatocellular carcinoma between 2017 and 2024. Predicted survival was calculated using a previously established prognostic model, and treatment benefits were evaluated by comparing observed survival with predicted outcomes. Logistic and linear regression analyses were performed to identify factors associated with survival gain.
Results
The median observed survival was 26.0 months, compared with a model‐predicted survival of 24.7 months. Treatment with atezolizumab plus bevacizumab was significantly associated with survival exceeding model predictions (odds ratio: 3.77, p = 0.0065). Linear regression analysis confirmed that atezolizumab plus bevacizumab was independently associated with a greater survival benefit (β = 0.192, p = 0.0084). Subgroup analysis demonstrated that this association was particularly pronounced in patients with high tumor burden (tumor number plus size ≥ 11), whereas no significant associations were observed for lenvatinib, STRIDE, or cabozantinib.
Conclusions
Atezolizumab plus bevacizumab was associated with survival beyond that predicted by a prognostic model in patients with BCLC‐B2 stage hepatocellular carcinoma, particularly those with high tumor burden. These findings should be considered exploratory and associative rather than evidence of a causal treatment effect.