Child-Pugh B 级 (CP-B) 癌症合并不可切除的肝细胞癌 (uHCC) 患者是否从积极抗癌治疗与最佳支持治疗 (BSC) 中获益尚存在争议。 评估基于免疫检查点抑制剂 (ICI) 的治疗的关联与 uHCC 和 CP-B 肝功能障碍患者的总生存 (OS) 对比 BSC。这项回顾性、多中心、国际临床病例系列研究了从 9 月份开始接受一线 ICI 治疗方案的 CP-B 伴 uHCC 患者的数据2017 年至 2022 年 12 月，其数据从一个国际联盟中提取，并与接受 BSC 的 CP-B 患者队列进行比较。患者在欧洲、美国和亚洲的三级护理中心接受常规临床实践治疗。应用纳入标准后，ICI 组和 BSC 组分别剩下 187 名和 156 名患者。计算以下变量的倾向评分：年龄、甲胎蛋白水平、Child-Pugh评分、肝外扩散、门静脉肿瘤血栓形成、肝硬化、腹水和东部肿瘤合作组基线表现状态。ICI组中的患者首先接受治疗使用阿特珠单抗加贝伐单抗 (A B) (n = 141) 或纳武单抗 (n = 46) 进行一线全身治疗。治疗权重逆概率 (IPTW) 人群中的 OS 是主要结果，并使用 Kaplan-Meier 进行估计方法;采用单变量Cox回归检验对两组进行比较。ICI组（33名女性[18%]）和BSC组的中位年龄分别为66（IQR，61-72）和73（IQR，66-81）岁（41 名女性 [26%]）。在 IPTW 人群中，与 BSC 组（4.04 个月；95% CI，3.03-5.03；风险比，0.59；95% CI， 0.43-0.80；P < .001)。多变量分析证实，ICI 暴露与死亡风险降低约 50%（风险比，0.55；95% CI，0.35-0.86；P < .001）以及门静脉肿瘤血栓形成的存在相关，东部肿瘤合作组表现评分大于 1 且甲胎蛋白水平为 400 ng/mL 或更高与死亡风险增加相关。该病例系列的结果提供了比较证据，表明与 ICI 治疗相比，ICI 治疗可提高生存率患有 CP-B 肝功能障碍的 uHCC 患者的 BSC。

Whether patients with Child-Pugh class B (CP-B) cancer with unresectable hepatocellular carcinoma (uHCC) benefit from active anticancer treatment vs best supportive care (BSC) is debated.To evaluate the association of immune checkpoint inhibitor (ICI)-based therapies vs BSC with overall survival (OS) of patients with uHCC and CP-B liver dysfunction.This retrospective, multicenter, international clinical case series examined data of patients with CP-B with uHCC who were receiving first-line ICI-based regimens from September 2017 to December 2022 whose data were extracted from an international consortium and compared with a cohort of patients with CP-B receiving BSC. Patients were treated in tertiary care centers across Europe, US, and Asia in routine clinical practice. After applying the inclusion criteria, 187 and 156 patients were left in the ICI and BSC groups, respectively. The propensity score was calculated for the following variables: age, alpha-fetoprotein levels, Child-Pugh score, extrahepatic spread, portal vein tumor thrombosis, cirrhosis, ascites, and baseline Eastern Cooperative Oncology Group performance status.Patients in the ICI group received first-line systemic therapy with either atezolizumab plus bevacizumab (A+B) (n = 141) or nivolumab (n = 46).OS in the inverse probability of treatment weighting (IPTW) populations was the main outcome, and it was estimated with Kaplan-Meier method; univariable Cox regression test was used to make comparisons between the 2 groups.The median age was 66 (IQR, 61-72) and 73 (IQR, 66-81) years in the ICI (33 women [18%]) and BSC groups (41 women [26%]), respectively. In the IPTW populations, median OS was significantly longer in the ICI group (7.50 months; 95% CI, 5.62-11.15) compared with BSC (4.04 months; 95% CI, 3.03-5.03; hazard ratio, 0.59; 95% CI, 0.43-0.80; P < .001). Multivariable analysis confirmed that ICI exposure was associated with a reduction of approximately 50% in the risk of death (hazard ratio, 0.55; 95% CI, 0.35-0.86; P < .001), and the presence of portal vein tumor thrombosis, an Eastern Cooperative Oncology Group performance score of greater than 1, and alpha-fetoprotein levels of 400 ng/mL or greater were associated with increased risk of death.The results of this case series provide comparative evidence of improved survival in association with ICI treatment compared with BSC in patients with uHCC with CP-B liver dysfunction.