간세포암종에 대해 아테졸리주맙-베바시주맙 및 렌바티닙 치료를 받는 환자의 정맥류 출혈의 위험도 평가

Abstract

Background and aims: There is limited real-world data on the actual risk of variceal bleeding (VB) in patients receiving atezolizumab-bevacizumab (Atezo-Bev) or lenvatinib treatment. This study was aimed to assess the risk of VB in patients with advanced hepatocellular carcinoma (HCC) receiving two treatments and to construct a predictive model for VB. Methods: This retrospective study included 585 patients with HCC who underwent endoscopy before Atezo-Bev (n = 476) or lenvatinib (n = 109) treatment at two hospitals in Korea. The primary outcome was the occurrence of VB. Non-VB event was considered as a competing event. Results: Of the 585 patients, 31 developed VB (4.7% at 6 months, 6.2% at 12 months), without significant difference in the risk of VB between the two treatments. The median follow-up was 6.1 months. No patient died from VB. In multivariable analysis, factors associated with an increased risk of VB were portal vein invasion (PVI, subdistribution hazard: 3.30, 95% confidence interval [CI]: 1.44-7.58), platelet <100,000 mm3 (SHR: 2.59, 95% CI: 1.23-5.45), and varices needing treatment (VNT, SHR: 3.79, 95% CI: 1.76-8.17). We built a prediction model PV100 consisting of PVI, low platelet count, VNT, and history of bleeding. Conclusion: A low platelet count, PVI, and VNT increased the risk of VB after Atezo-Bev or lenvatinib treatment for HCC. Our model PV100 can predict and assess the risk of VB risk in real-world settings. Keywords: Hepatocellular carcinoma; Lenvatinib; Bevacizumab; Bleeding