蛋白尿是阿替珠单抗联合贝伐单抗治疗不可切除肝细胞癌（HCC）的一种不良事件，可导致贝伐单抗的使用中断。然而，目前尚未研究接受阿替珠单抗联合贝伐单抗治疗的肝细胞癌患者蛋白尿的风险因素。本研究的目的是确定阿替珠单抗联合贝伐单抗治疗不可切除肝细胞癌患者早期发生蛋白尿的风险因素。对64例Child-Pugh评分为5-7、Eastern Cooperative Oncology Group活动状态为0或1、疗前蛋白尿水平低（尿液试纸检测结果为1+或更低，尿蛋白/肌酐比值小于2.0 g/g Cr）的患者进行了分析。根据不良事件的通用术语标准（版本5.0），评估了蛋白尿水平。我们采用尿蛋白/肌酐比值进行了定量测试，而不是24小时尿液收集。回顾性调查了蛋白尿的发生率和肝功能的变化。在24周的累积发生率达到34.4%。多变量分析显示，较低估计的肾小球滤过率（风险比[HR]，3.807；95%置信区间[CI]，1.579-9.180；p=0.003）、高血压治疗（HR，6.224；95% CI，1.614-24.010；p=0.008）和高收缩压（HR，2.649；95% CI，1.133-6.194；p=0.025）是蛋白尿的风险因素。患有蛋白尿的患者血清白蛋白水平和白蛋白-胆红素评分恶化。此外，在治疗期间平均收缩压≥135 mm Hg是发生严重蛋白尿（尿蛋白/肌酐比值>2 g/g Cr）的唯一风险因素。本研究发现，控制血压对于管理接受阿替珠单抗联合贝伐单抗治疗的肝细胞癌患者的蛋白尿非常重要。版权所有2022年作者。由S.Karger AG, Basel出版。

Proteinuria is one of the adverse events of atezolizumab plus bevacizumab combination therapy (Atezo + Bev) and can cause interruption in the use of Bev. However, the risk factors for proteinuria in patients with hepatocellular carcinoma (HCC) who are receiving Atezo + Bev have not yet been investigated. The aim of this study was to identify the risk factors for early onset of proteinuria in Atezo + Bev for patients with unresectable HCC.Sixty-four patients with Child-Pugh scores of 5-7, an Eastern Cooperative Oncology Group performance status of 0 or 1, and low level of proteinuria (1+ or less on a dipstick test and urine protein-to-creatinine ratio (UPCR) less than 2.0 g/g Cr) at the initiation of therapy were analyzed. The level of proteinuria was evaluated based on the Common Terminology Criteria for Adverse Events version 5.0. We adopted the UPCR for the quantitative test instead of a 24-h urine collection. The incidence of proteinuria and changes in liver function were retrospectively investigated.The cumulative incidence of proteinuria over a 24-week period was 34.4%. Multivariate analysis showed that a low estimated glomerular filtration rate (hazard ratio [HR], 3.807; 95% confidence interval [CI], 1.579-9.180; p = 0.003), treatment for hypertension (HR, 6.224; 95% CI, 1.614-24.010; p = 0.008), and high systolic blood pressure (SBP) (HR, 2.649; 95% CI, 1.133-6.194; p = 0.025) were risk factors for proteinuria. Serum albumin levels and albumin-bilirubin scores in patients with proteinuria worsened. In addition, a mean SBP ≥135 mm Hg during treatment was the only risk factor for the development of severe proteinuria (UPCR >2 g/g Cr).Our study found that controlling blood pressure is extremely important for the management of proteinuria in patients with HCC who are receiving Atezo + Bev.Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.