Sarcopenia predicts outcomes in patients with hepatocellular carcinoma treated with atezolizumab and bevacizumab: A multicenter cohort study

The combination of atezolizumab and bevacizumab (A+B) is now the standard of care for the first-line systemic treatment of unresectable hepatocellular carcinoma (HCC). This study aims to determine the potential prognostic value of sarcopenia and inflammatory biomarker in predicting the outcome of A+B treatment.

This is a retrospective, multi-center study that includes consecutive HCC patients received A+B treatment from September 2020 to December 2022. Pre-treatment computed tomography imaging was used to measure the cross-sectional area of skeletal muscle at the third lumbar vertebra, and the skeletal muscle index (SMI) was calculated by normalizing by patient`s height. The neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) were used as surrogate markers of inflammation and immune cell reservoir. The associations of factors on overall survival (OS) and progression free survival (PFS) were analyzed using Cox proportional hazards regression and multivariable logistic regression models.

The study included 150 patients, with a median age of 64 years, of whom 85.3% were male and 69.3% were classified as having HCC due to viral hepatitis etiology. Sarcopenia was found in 41.3% of the patients, while 50% had portal vein tumor thrombosis (PVTT), and 60.7% had extrahepatic spread (EHS). Median OS and PFS were 11.8 (95% CI, 7.9-23.0) and 5.6 months (95% CI, 4.0-9.5), respectively. In the response-evaluable patients (n = 131), objective response rate was 35.1%. Sarcopenia (HR, 2.027; 95% CI, 1.172-3.506, p=0.012), NLR ≥3 (HR, 1.879; 95% CI, 1.074-3.289, p=0.027), ALBI grade (≥2) (HR, 2.943; 95% CI, 1.031-8.398, p=0.044) and PVTT (HR, 1.884; 95% CI, 1.040-3.411, p=0.037) were independently associated with OS. Sarcopenia (HR, 1.774; 95% CI, 1.0.5-3.038, p=0.037) and EHS (HR, 2.532; 95% CI, 1.352.5-4.741, p=0.004) were independent predictors of PFS.

In this multi-center, retrospective cohort study provides evidence that sarcopenia and inflammatory biomarker are important predictors of prognosis in patients with HCC receiving A+B treatment. Taking these factors into consideration can aid in making treatment decisions and predicting outcomes. Further research is needed to better identify high-risk HCC patients with sarcopenia or systemic inflammation.

The authors.

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All authors have declared no conflicts of interest.