Discordant Antitumor Efficacy with Compromised Survival in High-Risk Unresectable Hepatocellular Carcinoma

Background/Objectives: Real-world data in high-risk patients remain limited; this study evaluated survival, safety, and prognostic factors in this patient group. Methods: This multicenter study retrospectively reviewed 783 patients who received Ate/Bev from 2022–2024 across South Korea. High-risk patients (n = 252, 32.2%) were defined by main portal vein tumor thrombus (Vp4), tumor occupancy ≥50% of liver volume, or bile duct invasion. Propensity score matching (PSM) was performed to balance host-related factors between the high-risk and non-high-risk (n = 531) groups. Results: After PSM (251 pairs, n = 502), overall survival (median 10.4 vs. 14.9 months; HR 1.57, 95% CI 1.28–1.92, p < 0.001) and progression-free survival (median 6.0 vs. 6.8 months; HR 1.29, 95% CI 1.08–1.53, p = 0.009) remained significantly worse in the high-risk group. Objective response (25.1% vs. 19.9%, p = 0.200) and disease control rates (71.7% vs. 76.5%, p = 0.262) were comparable. Among 103 responders with documented response-onset dates, an exploratory complete-case analysis showed a numerically shorter duration of response in the high-risk group, although the difference did not reach statistical significance (median, 7.1 vs. 11.3 months; HR, 1.57; 95% CI, 0.97–2.55; p = 0.065). Conclusions: Ate/Bev achieved similar antitumor response rates in high-risk and non-high-risk patients, but survival remained poorer in the high-risk group. High-risk status therefore did not preclude antitumor activity with Ate/Bev.

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Publication Details

Journal
Cancers
Published
2026-09-10
DOI
https://doi.org/10.3390/cancers18182932
Primary Topic
Hepatocellular Carcinoma Treatment and Prognosis
Type
article
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article

Discordant Antitumor Efficacy with Compromised Survival in High-Risk Unresectable Hepatocellular Carcinoma

Sang Youn Hwang, Won Young Tak, Joonho Jeong, Hyun Chin Cho et al.
Cancers
Hepatocellular Carcinoma Treatment and Prognosis
article

Discordant Antitumor Efficacy with Compromised Survival in High-Risk Unresectable Hepatocellular Carcinoma

Sang Youn Hwang, Won Young Tak, Joonho Jeong, Hyun Chin Cho, Jun Sik Yoon, Yang Hyun Baek, Hyun Young Woo, Jae Hyun Yoon, Jeong Heo, Yeo Wool Kang, Woo Sun Rou, Soo Young Park, Young Eun Seo, Jeong Eun Song, Won Jae Lee, Young Mi Hong, Chan Joong Bae, Sun Young Chun, Sung Bum Cho, Hong Jung Pyo, Yu Rim Lee
article en

Abstract

Background/Objectives: Real-world data in high-risk patients remain limited; this study evaluated survival, safety, and prognostic factors in this patient group. Methods: This multicenter study retrospectively reviewed 783 patients who received Ate/Bev from 2022–2024 across South Korea. High-risk patients (n = 252, 32.2%) were defined by main portal vein tumor thrombus (Vp4), tumor occupancy ≥50% of liver volume, or bile duct invasion. Propensity score matching (PSM) was performed to balance host-related factors between the high-risk and non-high-risk (n = 531) groups. Results: After PSM (251 pairs, n = 502), overall survival (median 10.4 vs. 14.9 months; HR 1.57, 95% CI 1.28–1.92, p < 0.001) and progression-free survival (median 6.0 vs. 6.8 months; HR 1.29, 95% CI 1.08–1.53, p = 0.009) remained significantly worse in the high-risk group. Objective response (25.1% vs. 19.9%, p = 0.200) and disease control rates (71.7% vs. 76.5%, p = 0.262) were comparable. Among 103 responders with documented response-onset dates, an exploratory complete-case analysis showed a numerically shorter duration of response in the high-risk group, although the difference did not reach statistical significance (median, 7.1 vs. 11.3 months; HR, 1.57; 95% CI, 0.97–2.55; p = 0.065). Conclusions: Ate/Bev achieved similar antitumor response rates in high-risk and non-high-risk patients, but survival remained poorer in the high-risk group. High-risk status therefore did not preclude antitumor activity with Ate/Bev.

CancersVol. 18(18)
Ulsan College (KR), Gyeongsang National University (KR), Chungnam National University (KR), Kyungpook National University Hospital (KR), Daegu Catholic University (KR), University of Ulsan (KR), Daegu Catholic University Medical Center (KR), Chonnam National University Hospital (KR), Pusan National University Hospital (KR), Ulsan University Hospital (KR), Dongnam Institute of Radiological & Medical Sciences (KR), Pusan National University Yangsan Hospital (KR), Dong-A University (KR), Keimyung University (KR)
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Openalex Percentile: Top 12%
Hepatocellular Carcinoma Treatment and Prognosis
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