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. 2025 Aug;45(8):e70217.
doi: 10.1111/liv.70217.

Vascular Invasion Within the Resectability Criteria Is a Prognostic Factor in Patients Treated With Atezolizumab and Bevacizumab

Tomomitsu Matono  1 , Toshifumi Tada  2   3 , Takashi Kumada  4 , Atsushi Hiraoka  5 , Masashi Hirooka  6 , Kazuya Kariyama  7 , Joji Tani  8 , Masanori Atsukawa  9 , Koichi Takaguchi  10 , Ei Itobayashi  11 , Shinya Fukunishi  12 , Hiroki Nishikawa  13 , Kazunari Tanaka  14 , Kunihiko Tsuji  14 , Toru Ishikawa  15 , Kazuto Tajiri  16 , Yuichi Koshiyama  17 , Hidenori Toyoda  17 , Chikara Ogawa  18 , Takeshi Hatanaka  19 , Satoru Kakizaki  20 , Kazuhito Kawata  21 , Hideko Ohama  5 , Fujimasa Tada  5 , Kazuhiro Nouso  7 , Asahiro Morishita  8 , Akemi Tsutsui  10 , Takuya Nagano  10 , Norio Itokawa  9 , Tomomi Okubo  9 , Taeang Arai  9 , Takashi Nishimura  12 , Michitaka Imai  15 , Hisashi Kosaka  22 , Atsushi Naganuma  23 , Tomoko Aoki  24 , Hidekatsu Kuroda  25 , Yutaka Yata  26 , Hideyuki Tamai  27 , Takanori Matsuura  2 , Shohei Komatsu  28 , Yoshihide Ueda  29 , Yoshiko Nakamura  6 , Osamu Yoshida  6 , Kosuke Matsui  22 , Shinichiro Nakamura  3 , Hirayuki Enomoto  12 , Masaki Kaibori  22 , Takumi Fukumoto  28 , Yoichi Hiasa  6 , Masatoshi Kudo  24 ; Real‐life Practice Experts for HCC (RELPEC) Study Group and the Hepatocellular Carcinoma Experts from 48 clinics in Japan (HCC 48) Group
Affiliations

Vascular Invasion Within the Resectability Criteria Is a Prognostic Factor in Patients Treated With Atezolizumab and Bevacizumab

Tomomitsu Matono et al. Liver Int. 2025 Aug.

Abstract

Background and aims: To assess the outcomes of patients with hepatocellular carcinoma (HCC) who were treated with atezolizumab plus bevacizumab (Atezo/Bev), categorised by oncological resectability criteria, which reflect tumour burden and extent of disease.

Methods: A cohort of 467 HCC patients who received Atezo/Bev was enrolled. Patients were classified into two groups based on oncological resectability criteria: BR (borderline resectable) 1 (n = 153) and BR2 (n = 314).

Results: The median progression-free survival (PFS) was 9.0 months in the BR1 group and 6.8 months in the BR2 group (p = 0.014). Multivariable analysis identified the following independent prognostic factors for PFS: age ≥ 75 years (hazard ratio [HR], 1.309), albumin-bilirubin (ALBI) grade ≥ 2 (HR, 1.494), neutrophil-to-lymphocyte ratio (NLR) ≥ 3 (HR, 1.289), α-fetoprotein ≥ 100 ng/mL (HR, 1.523) and BR2 classification (HR, 1.360). The median overall survival (OS) was 25.3 months in the BR1 group and 22.3 months in the BR2 group (p = 0.048). Multivariable analysis identified the following independent prognostic factors for OS: age ≥ 75 years (HR, 1.522), ALBI grade ≥ 2 (HR, 2.411), NLR ≥ 3 (HR, 1.635), α-fetoprotein ≥ 100 ng/mL (HR, 1.530) and BR2 classification (HR, 1.421). When oncological resectability factors (tumour number and size, vascular invasion and extrahepatic spread) were incorporated into the multivariable analysis, major vascular invasion emerged as a significant predictor of both PFS (HR, 3.188) and OS (HR, 2.650).

Conclusions: In patients with HCC characterised by limited resectability undergoing Atezo/Bev, vascular invasion, in addition to liver function, is a critical prognostic determinant of tumour progression.

Keywords: ALBI grade; atezolizumab plus bevacizumab; hepatocellular carcinoma; oncological resectability criteria; vascular invasion.

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