Factors Affecting an Increase in Spleen Volume and Association of Spleen Volume Variation with the Clinical Outcomes of Atezolizumab and Bevacizumab Treatment for Hepatocellular Carcinoma: A Retrospective Analysis

Abstract

Plain Language SummaryImmunotherapy is now the standard of care for systemic therapy in hepatocellular carcinoma (HCC). The combination of atezolizumab and bevacizumab (Atez/Bev) is recommended for the first-line treatment, while gastrointestinal varices rupture is likely to be observed during Atez/Bev. Gastrointestinal varices rupture is a fatal event and developed due to portal hypertension. Spleen volume (SpV) plays an important role in portal hypertension based on previous studies, and we examined variation in SpV during Atez/Bev treatment and investigated predictive factors that affect the increase in SpV and the association of SpV variation and pretreatment SpV with the clinical outcome of Atez/Bev. The median pretreatment SpV was 184 (130–257) cm3 and the median SpV variation was 27 (9–60) cm3. An increase in the SpV was observed in 140 patients (85.4%). Age <74 years (p = 0.03), mALBI grade 2b or 3 (p = 0.03), and pretreatment SpV ≥184 cm3 (p < 0.001) were significantly associated with increased SpV. The present study revealed that there were no significant differences in progression-free survival and overall survival between patients with and without pretreatment spleen enlargement, as well as between patients with SpV variation ≥25 cm³ and those with SpV variation <25 cm³. In conclusion, caution is warranted to detect the aggravation of portal hypertension when administering Atez/Bev to young patients or those with an impaired liver function or pretreatment spleen enlargement. The impact of spleen modulation by Atez/Bev appears to be limited on clinical efficacy.