Subset of Child-Pugh Score 7 Shows Comparable Survival Outcomes to Child-Pugh Score 6 in Hepatocellular Carcinoma Patients Treated with Atezolizumab and Bevacizumab

Abstract Purpose: Given the limited data on the effectiveness of Atezolizumab plus Bevacizumab (Ate/Bev) in HCC patients with a Child-Pugh score (CPS) of 7, this study aims to evaluate the treatment’s efficacy in this population and identify specific CPS 7 subgroups that may benefit from it. Experimental Design: This study included patients with advanced HCC who received Ate/Bev as first-line therapy between September 2020 and December 2023 at seven university hospitals. The primary outcome was OS, while secondary outcomes included PFS and treatment response. Results: Among the 374 included patients, those with CPS 5 (n=169) demonstrated the highest OS and PFS, followed by patients with CPS 6 (n=105) and CPS 7 (n=100) (P<0.05). For the variables comprising CPS, the HR for OS increased with elevated TB levels and was lower in patients with mild ascites (P<0.05). The HR for OS tended to increase as albumin levels dropped to 2.8 g/dL. Based on these findings, CPS 7 patients were further classified into two subgroups: favorable (TB <2 mg/dL, 3.5 ≥ Alb ≥ 2.8 g/dL, mild ascites, and absence of hepatic encephalopathy) and unfavorable (other CPS 7). Compared to patients with CPS 6, those in the favorable CPS 7 group exhibited comparable OS and PFS, while unfavorable CPS 7 patients had significantly lower OS and PFS (P<0.05). These findings were consistently observed in the multivariate analysis. Conclusions: This study suggests that Ate/Bev treatment can be effective in subset of CPS 7 patients, highlighting the potential to broaden treatment eligibility for this population.