Predictive values of sarcopenia for unresectable hepatocellular carcinoma treated with transarterial chemoembolization combining atezolizumab plus bevacizumab.

e16281 Background: The relationship between sarcopenia and the prognosis of patients with unresectable hepatocellular carcinoma (uHCC) who underwent transarterial chemoembolization (TACE) combining atezolizumab plus bevacizumab (TACE-Atezo/Bev) has not been reported. We conducted this retrospective study to elucidate the clinical impact of sarcopenia on the prognosis of these uHCC patients. Methods: Between August 2021 and May 2024, consecutive HCC patients who received TACE-Atezo/Bev were included and clinical information was collected. Skeletal muscle mass index (SMI) was calculated as skeletal muscle area at the L3 vertebra divided by the square of height. Patients were stratify based on SMI as sarcopenia (SMI ≤ 42 cm2/m2 for men or SMI ≤ 38 cm2/m2 for women) and non-sarcopenia groups. The progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) were analyzed. Results: A total of 75 patients were enrolled, with a median follow-up duration of 19.4 months. The median PFS in the non-sarcopenia group was significantly longer than that in the sarcopenia group (14.0 vs. 6.1 months, P < 0.001). The 12-month OS rates were 82.5% in non-sarcopenia group and 75.5% in sarcopenia group, respectively. The non-sarcopenia group showed a higher ORR than the sarcopenia group (69.6% vs 41.4%, P = 0.016). Multivariate analyses revealed that neutrophil-to-lymphocyte ratio, extrahepatic metastasis and sarcopenia were significant predictors for PFS (all P < 0.05). There was a significant reduction in SMI in patients with baseline NLR ≥ 3 following 6 months of treatment ( P < 0.001). Conclusions: Sarcopenia appeared as an unfavorable index for tumor response in these patients treated with TACE-Atezo/Bev model.