Survival Outcomes Associated With Radiological Progressive Disease Subtypes in Patients With Atezolizumab and Bevacizumab–Treated HCC
Tomomitsu Matono, Toshifumi Tada, Takashi Kumada, Atsushi Hiraoka, Masashi Hirooka, Kazuya Kariyama, Joji Tani, Masanori Atsukawa, Koichi Takaguchi, Ei Itobayashi, Shinya Fukunishi, Hiroki Nishikawa, Kazunari Tanaka, Kunihiko Tsuji, Toru Ishikawa, Kazuto Tajiri, Yuichi Koshiyama, Hidenori Toyoda, Chikara Ogawa, Takeshi Hatanaka, Satoru Kakizaki, Kazuhito Kawata, Hideko Ohama, Fujimasa Tada, Kazuhiro Nouso, Asahiro Morishita, Akemi Tsutsui, Takuya Nagano, Norio Itokawa, Tomomi Okubo, Taeang Arai, Takashi Nishimura, Michitaka Imai, Hisashi Kosaka, Atsushi Naganuma, Tomoko Aoki, Hidekatsu Kuroda, Yutaka Yata, Yoshiko Nakamura, Osamu Yoshida, Shinichiro Nakamura, Hirayuki Enomoto, Masaki Kaibori, Yoichi Hiasa, Masatoshi Kudo, ,ABSTRACT
Background and Aim
To assess the relationship between survival outcomes and subtypes of radiological progressive disease (PD) in patients with hepatocellular carcinoma (HCC) treated with atezolizumab and bevacizumab (Atezo/Bev).
Methods
A total of 462 patients with Atezo/Bev‐treated HCC diagnosed with radiological PD during follow‐up were enrolled. PD was classified into three categories: progression or emergence of intrahepatic lesions (PD‐IH), macroscopic vascular invasion (PD‐MVI), and extrahepatic spread lesions (PD‐EHS). We defined PD‐multiple as the presence of two or more PD categories. Subsequent analysis was categorized into the “PD‐IH or PD‐EHS” and “PD‐MVI or PD‐multiple” groups.
Results
The median progression‐free survival (PFS) durations for patients with PD‐IH, PD‐MVI, PD‐EHS, and PD‐multiple were 5.3, 3.2, 3.9, and 3.5 months (p = 0.003). Patients with “PD‐IH or PD‐EHS” and “PD‐MVI or PD‐multiple” had median PFS of 5.2 and 3.5 months (p < 0.001). Median overall survival (OS) for PD‐IH, PD‐MVI, PD‐EHS, and PD‐multiple was 22.3, 15.1, 19.4, and 14.2 months (p = 0.002). The OS for patients with “PD‐IH or PD‐EHS” and “PD‐MVI or PD‐multiple” was 21.4 and 14.5 months (p < 0.001). Multivariate analysis demonstrated that ECOG‐PS ≥ 1 (hazard ratio (HR), 1.508), α‐fetoprotein levels ≥ 100 ng/mL (HR, 1.293), albumin–bilirubin grade ≥ 2 (HR, 1.573), liver cirrhosis (HR, 1.361), and PD subtypes PD‐MVI or PD‐multiple (HR, 1.735) were independently associated with OS.
Conclusions
Patients with HCC undergoing Atezo/Bev treatment, diagnosed with PD‐multiple (not solely based on IH or EHS) or PD‐MVI, experienced poor prognosis, specifically in terms of OS.