O3- RECOMPENSATION IN PATIENTS WITH CIRRHOSIS PRIOR TO FIRST LINE SYSTEMIC THERAPY IS ASSOCIATED WITH SIMILAR SURVIVAL OUTCOMES COMPARED TO COMPENSATED CIRRHOSIS

No The term “recompensation” of cirrhosis was proposed in the latest BAVENO VII, underlying dynamic events and prognosis in cirrhosis. However, there is uncertainty regarding its prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with first line systemic therapies (1L). We aimed to compare post-1L survival between compensated (CC), decompensated (DC), and recompensated (RC) cirrhosis. A multicenter prospective Latin-American cohort study including advanced HCC patients with cirrhosis who received any 1L was conducted from 2018 to 2024. Three groups were defined: CC (had never presented decompensation); DC (presenting any decompensated event associated with portal hypertension at time of 1L), and RC group (prior history of any decompensation event at HCC diagnosis who were compensated at time of 1L). Survival since date of 1L was compared using Cox proportional hazard analysis. Overall, 306 patients received 1L, including sorafenib 60.5%, atezolizumab + bevacizumab 29.7%, lenvatinib 9.1%, and nivo/pembrolizumab 0.6%. Of these, 83.3% presented cirrhosis. Median 1L treatment duration was 5.1 months with a median overall survival since 1L of 16.0 months (range 12.9-18.3). Significant differences were observed between CC (n=167), DC (n=31) and RC (n=42) groups (Table). In the RC group, median time from decompensation to recompensation was 12.0 months (range 1.9-25.9); being ascites the most frequent event (78.6%). DC group presented decreased post-1L survival [median 8.6 months vs 17.2 months in CC [adjusted HR 1.9 (95% CI 1.05-3.5); P=0.03], while no significant survival difference was observed between RC and CC [median survival 12.5 months; aHR 1.3 (95% CI 0.81-2.1); P=0.28] (Figure). Lower access to second line therapy was observed in DC group. Patients with cirrhosis and advanced HCC who achieve recompensation may benefit from systemic therapies. This demands an observation period of follow up before precluding 1L in decompensated cirrhosis.