Atezolizumab Plus Bevacizumab Combined with Transarterial Embolization Plus Hepatic Arterial Infusion Chemotherapy for Unresectable Hepatocellular Carcinoma with a Diameter >8 Cm: A Retrospective Study

Figures & data

Figure 1 Patient selection flowchart.

Table 1 Baseline Characteristics of the Patients

Baseline Variables	n=30
Sex, n (%)
Male	28 (96.97%)
Female	2 (3.03%)
Age (years), median (IQR)	55.5 (49.0–66.0)
BMI (kg/m^2), median (IQR)	22.71 (20.47–25.25)
ECOG PS, n (%)
0	21 (70.00%)
1	9 (30.00%)
Viral hepatitis, n (%)
B	29 (96.67%)
C	0
None	1 (3.33%)
AFP (nf/mL), median (IQR)	391.8 (14.16–9656.99)
AFP (μg/L), n (%)
<400	16 (53.33%)
≥400	14 (46.67%)
Neutrophils (×109/L), median (IQR)	4.11 (3.30–5.78)
Lymphocyte (×109/L), median (IQR)	1.49 (1.02–1.78)
AST (U/L), median (IQR)	65.00 (46.00–119.00)
AST (U/L), n (%)
<37	4 (13.33%)
≥37	26 (86.67%)
ALT (U/L), median (IQR)	45.00 (28.00–76.00)
ALT (U/L), n (%)
<40	12 (40.00%)
≥40	18 (60.00%)
Child-Pugh, n (%)
A	20 (66.67%)
B	10 (33.33%)
Tumor number, n (%)
<3	6 (20.00%)
≥3	24 (80.00%)
Maximum tumor diameter (cm), median (IQR)	11.6 (9.8–13.2)
Maximum tumor diameter (cm), n (%)
8–10	8
>10	22
Extrahepatic metastasis, n (%)
No	19 (63.33%)
Yes	11 (36.67%)
PVTT (Vp), n (%)
None	10(33.3%)
II	4 (13.33%)
III	7 (23.3%)
IV	9 (30.00%)
BCLC, n (%)
B	10 (33.33%)
C	20 (66.67%)
Tumor/liver volume ratio, n (%)
<50%	14 (46.67%)
≥50%	16 (53.33%)
Number of treatments, mean±SD
TAE+HAIC	3.6±1.9
Atezolizumab-bevacizumab	7.8±2.4

Abbreviations: IQR, interquartile range; BMI, body mass index; ECOG PS, Eastern Cooperative Oncology Group performance status; AFP, α-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; PVTT, portal vein tumor thrombus; BCLC, Barcelona Clinic liver cancer; TAE, transarterial embolization; HAIC, hepatic arterial infusion chemotherapy.

Table 2 Treatment Effectiveness

	N=30
Complete response	2 (6.7%)
Partial response	20 (67.7%)
Stable disease	6 (25%)
Progressive disease	2 (6.7%)
Objective response rate	74.4%
Disease control rate	93.3%

Figure 2 (A) Kaplan-Meier curve for progression-free survival (PFS). (B) Kaplan-Meier curve for overall survival (OS).

Figure 3 Kaplan-Meier curves for progression-free survival (PFS) after stratification for the absence/presence of extrahepatic metastasis.

Table 3 Univariable and Multivariable Cox Analyses for PFS

Variables	Univariable			Multivariable
	HR	95% CI	P	HR	95% CI	P
Age (≤60)	0.907	0.296–2.778	0.865
BMI (≥25)	1.127	0.408–3.114	0.818
Sex (male)	22.633	0.001–48.027	0.539
AFP ≥400 μg/L	3.29	1.042–10.367	0.042	1.276	0.351–4.631	0.711
AST ≥37 U/L	2.515	0.325–19.477	0.377
ALT ≥40 U/L	1.446	0.48–4.356	0.512
Child-Pugh (A)	1.383	0.495–3.869	0.536
Tumor number (≤3)	0.888	0.191–4.132	0.879
Maximum diameter of the tumor (8–10cm)	0.768	0.239–2.468	0.658
PVTT (yes)	14.515	1.875–21.350	0.011	6.893	0.778–61.048	0.083
Extrahepatic metastasis (yes)	7.611	2.511–23.075	0.000335	3.468	1.001–12.023	0.047
BCLC (C)	1.951	0.546–6.968	0.304

Abbreviations: HR, hazard ratio; CI, confidence interval; BMI, body mass index; AFP, α-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; PVTT, portal vein tumor thrombus; BCLC, Barcelona Clinic liver cancer.

Table 4 Safety

Adverse events	Any grade	Grade 1	Grade 2	Grade 3	Grade 4
Hypertension	6 (20%)	4 (13.3%)	2 (6.7%)	0	0
Albuminuria	7 (23.3%)	5 (16.7%)	2 (6.7%)	0	0
Fever	14 (46.7%)	9 (30%)	3 (10%)	2 (6.7%)	0
ALT increase	12 (40%)	8 (26.7%)	3 (10%)	1 (3.3%)	0
AST increase	13 (43.3%)	10 (33.3%)	2 (6.7%)	1 (3.3%)	0
Increase in total bilirubin	9 (30%)	6 (20%)	3 (10%)	0	0
Hypothyrea	5 (16.7%)	3 (10%)	1 (3.3%)	1 (3.3%)	0
Diarrhea	9 (30%)	5 (16.7%)	2 (6.7%)	2 (6.7%)	0
Loss of weight	9 (30%)	6 (20%)	3 (10%)	0	0
Loss of appetite	12 (40%)	9 (30%)	3 (10%)	0	0
Thrombocytopenia	6 (20%)	5 (16.7%)	1 (3.3%)	0	0
Emesis	14 (46.7%)	10 (33.3%)	3 (10%)	1 (3.3%)	0
Hematemesis	1 (3.3%)	0	0	0	1 (3.3%)