Outcomes of patients with Child-Pugh B and unresectable hepatocellular carcinoma undergoing first-line systemic treatment with sorafenib, lenvatinib, or atezolizumab plus bevacizumab

Background: Systemic therapy is recommended for patients with Child-Pugh A in hepatocellular carcinoma (HCC.) We analyzed the outcomes of a cohort of patients with HCC and who received either sorafenib (Sor), lenvatinib (Len) or atezolizumab plus bevacizumab (Atezo + Bev)as first-line systemic therapy for HCC, with the aim of identifying prognostic factors for survival.Methods:A total of 825 patients with advanced HCC and Child-Pugh A or B received either Sor, Len, or Atezo + Bev as first-line systemic therapy. Liver function was assessed according to the Child-Pugh score and the modified albumin-bilirubin (mALBI) grade. Results:When prognosis was analyzed according to liver function such as Child-Pugh classifications, scores and mALBI grades, that worsened with a decline in liver function (p < 0.001 for all). A Child-Pugh score of 7 was a factor significantly associated with OS. In patients with a Child-Pugh score of 7, a mALBI grade of 3 was an independent predictor of OS. InChild-Pugh B patients with HCC, receiving Atezo + Bev was identified as a factor associated with PFS. Conclusion: Determining the hepatic reserve of patients with unresectable HCC might be useful for identifying patents suitable for systemic treatment for HCC. Atezo + Bev might prolong the PFS of patients with a Child-Pugh score of 7.