不可切除肝细胞癌患者中阿替唑肽加貝伐珠單抗治療與肌肉體積流失的關聯性：多中心分析。
Relationship of Atezolizumab plus Bevacizumab Treatment with Muscle Volume Loss in Unresectable Hepatocellular Carcinoma Patients: Multicenter Analysis.
发表日期：2023 Aug
作者：
Atsushi Hiraoka, Takashi Kumada, Toshifumi Tada, Masashi Hirooka, Kazuya Kariyama, Joji Tani, Masanori Atsukawa, Koichi Takaguchi, Ei Itobayashi, Shinya Fukunishi, Kunihiko Tsuji, Toru Ishikawa, Kazuto Tajiri, Hironori Ochi, Satoshi Yasuda, Hidenori Toyoda, Chikara Ogawa, Takashi Nishimura, Takeshi Hatanaka, Satoru Kakizaki, Noritomo Shimada, Kazuhito Kawata, Atsushi Naganuma, Masaki Kaibori, Takaaki Tanaka, Hideko Ohama, Kazuhiro Nouso, Asahiro Morishita, Akemi Tsutsui, Takuya Nagano, Norio Itokawa, Tomomi Okubo, Taeang Arai, Michitaka Imai, Yohei Koizumi, Shinichiro Nakamura, Kouji Joko, Hiroko Iijima, Hisashi Kosaka, Yoichi Hiasa, Masatoshi Kudo
来源：
Liver Cancer
摘要：
目前尚无关于阿替唑珠单抗联合贝伐单抗（Atez/Bev）治疗不能切除的肝细胞癌（u-HCC）患者肌肉容积损失（MVL）的报道。本研究旨在阐明MVL和Atez/Bev之间的临床关系。从2020年9月至2021年12月，纳入了229例接受Atez/Bev治疗且基线时通过计算机断层扫描获得肌肉容积数据的u-HCC患者（中位年龄74岁，男性186例（81.2％）；ECOG PS 0/1级221例（96.5％）；HCV:HBV:酒精:其他 = 81:33:40:75；Child-Pugh A级212例（92.6％）；改良白蛋白-胆红素（mALBI）分级1:2a:2b = 79:60:90；BCLC 0:A:B:C = 1:24:87:117；中位随访期6.8个月）。使用日本肝病学会的标准定义MVL，并进行回顾性评估预后因素。多变量Cox风险分析显示，AFP（≥100 ng/mL）升高（HR 1.848，95％ CI 1.264-2.702，p = 0.002）、mALBI分级（≥2a）（HR 1.563，95％ CI 1.035-2.359，p = 0.034）和MVL（HR 1.479，95％ CI 1.020-2.144，p = 0.039）是进展无瘤生存期（PFS）的显著因素。对于总生存期（OS），显著因素包括AFP（≥100 ng/mL）升高（HR 3.564，95％ CI 1.856-6.844，p < 0.001）、mALBI分级（≥2a）（HR 3.451，95％ CI 1.580-7.538，p = 0.002）和MVL（HR 2.119，95％ CI 1.150-3.904，p = 0.016）。 MVL组（n = 91）的PFS较非MVL组（n = 138）较差（中位PFS为5.3 vs. 7.6个月，p = 0.025），而MVL组的OS较差（p = 0.038），但中位生存期均未达到。在接受Atez/Bev治疗的u-HCC患者中，MVL可能是与预后不良相关的临床因素。版权所有© 2022年作者。由S. Karger AG, Basel出版。
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.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.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, p = 0.002), mALBI grade (≥2a) (HR 1.563, 95% CI 1.035-2.359, p = 0.034), and MVL (HR 1.479, 95% CI 1.020-2.144, p = 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, p < 0.001), mALBI grade (≥2a) (HR 3.451, 95% CI 1.580-7.538, p = 0.002), and MVL (HR 2.119, 95% CI 1.150-3.904, p = 0.016). Patients with MVL (MVL group, n = 91) showed worse PFS than those without (non-MVL group, n = 138) (median PFS 5.3 vs. 7.6 months, p = 0.025), while the MVL group showed worse OS (p = 0.038), though neither reached the median survival time.MVL may be a clinical factor related to poor prognosis in patients receiving Atez/Bev treatment for u-HCC.Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.