肝功能恶化是晚期肝细胞癌（HCC）患者死亡的主要原因。我们评估了免疫检查点抑制剂 (ICI) 治疗对肝功能和结局的影响。纳入了 2003 年 4 月至 2024 年 5 月期间接受 ICI 或索拉非尼治疗的 HCC 患者。在 ICI 治疗开始时（基线，BL）以及此后 3 个月和 6 个月评估肝功能（通过 Child-Pugh 评分 [CPS] 评估）。 CPS ≥1 分变化定义为恶化 (-) 或改善 ( )，而相等的 CPS 分定义为稳定 (=)。 总体而言，182 名接受 ICI 治疗的患者（66.8 ± 11.8 岁；肝硬化：n = 134， 74%）被包括在内。在 BL 时，中位 CPS 为 5（IQR：5-6；CPS-A：147，81%）。 3 个月后，102 名 (56%) 患者的肝功能改善/稳定，61 名 (34%) 患者的肝功能恶化，而 19 名 (10%) 患者死亡/缺失随访 (d/noFU)。 6 个月时观察到可比结果（/=：n = 82, 45%；-：n = 55, 30%；d/noFU：n = 45, 25%）。相比之下，160 名索拉非尼患者中分别有 54 名 (34%) 和 33 名 (21%) 在 3 个月和 6 个月时实现了改善/稳定。放射学反应与 6 个月时 CPS 的改善/稳定相关（有反应者与无反应者，73% 与 50%；p = 0.007）。 6 个月时的 CPS 改善/稳定与里程碑分析后更好的总体生存率相关（6 个月：/=：28.4 [95% CI：18.7-38.1] 对比 -：14.2 [95% CI：10.3-18.2] 个月；p < 0.001）。在 BL 时患有 CPS-B 的 35 名 ICI 患者中，16 名 (46%) 名患者出现改善/稳定，而 19 名 (54%) 名患者在 3 个月时病情恶化/d/noFU。 6 个月时观察到了可比较的结果（CPS /=：14, 40%，-: 8, 23%）。重要的是，6/35 (17%) 和 9/35 (26%) 的患者在 3 个月和 6 个月时从 CPS-B 改善到 CPS-A。ICI 治疗的放射学反应与肝功能的稳定或改善相关，这即使对于基线时处于 Child-Pugh B 级的患者，也与改善生存相关。© 2024 作者。 《联合欧洲胃肠病学杂志》由 Wiley periodicals LLC 代表联合欧洲胃肠病学出版。

Deterioration of liver function is a leading cause of death in patients with advanced hepatocellular carcinoma (HCC). We evaluated the impact of immune checkpoint inhibitor (ICI)-treatment on liver function and outcomes.HCC patients receiving ICIs or sorafenib between 04/2003 and 05/2024 were included. Liver function (assessed by Child-Pugh score [CPS]) was evaluated at the start of ICI-treatment (baseline, BL) and 3 and 6 months thereafter. A ≥1 point change in CPS was defined as deterioration (-) or improvement (+), while equal CPS points were defined as stable (=).Overall, 182 ICI-treated patients (66.8 ± 11.8 years; cirrhosis: n = 134, 74%) were included. At BL, median CPS was 5 (IQR: 5-6; CPS-A: 147, 81%). After 3 months, liver function improved/stabilized in 102 (56%) and deteriorated in 61 (34%) patients, while 19 (10%) patients deceased/had missing follow-up (d/noFU). Comparable results were observed at 6 months (+/=: n = 82, 45%; -: n = 55, 30%; d/noFU: n = 45, 25%). In contrast, 54 (34%) and 33 (21%) out of 160 sorafenib patients achieved improvement/stabilization at 3 and 6 months, respectively. Radiological response was linked to CPS improvement/stabilization at 6 months (responders vs. non-responders, 73% vs. 50%; p = 0.007). CPS improvement/stabilization at 6 months was associated with better overall survival following landmark analysis (6 months: +/=: 28.4 [95% CI: 18.7-38.1] versus -: 14.2 [95% CI: 10.3-18.2] months; p < 0.001). Of 35 ICI-patients with CPS-B at BL, improvement/stabilization occurred in 16 (46%) patients, while 19 (54%) patients deteriorated/d/noFU at 3 months. Comparable results were observed at 6 months (CPS +/=: 14, 40%, -: 8, 23%). Importantly, 6/35 (17%) and 9/35 (26%) patients improved from CPS-B to CPS-A at 3 and 6 months.Radiological response to ICI-treatment was associated with stabilization or improvement in liver function, which correlated with improved survival, even in patients with Child-Pugh class B at baseline.© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.