BACKGROUND: The prognostic value of curative therapies-including liver transplantation, hepatectomy, and local ablation-in patients with advanced hepatocellular carcinoma (HCC) following atezolizumab plus bevacizumab treatment remains unclear. This study evaluated the feasibility of curative therapy and compared survival outcomes between patients who did and did not undergo curative interventions following atezolizumab plus bevacizumab, using a propensity score-matched (PSM) analysis. METHODS: We retrospectively analyzed 318 consecutive patients with advanced HCC who received atezolizumab plus bevacizumab between 2020 and 2024. Overall survival (OS) and progression-free survival (PFS) were defined as the primary and secondary endpoints, respectively. Survival outcomes were estimated using the Kaplan-Meier method and evaluated with multivariate Cox proportional hazards regression, modeling exposure to conversion curative therapy as a time-dependent covariate. RESULTS: The objective response rate to atezolizumab plus bevacizumab was 34.6%. Thirty-six patients (11%) subsequently underwent curative therapy, including liver transplantation (n = 8, 2.5%), hepatectomy (n = 11, 3.5%), and local ablation (n = 17, 5.3%). Patients receiving curative therapy demonstrated significantly improved OS (p < 0.001) and PFS (p < 0.001) compared with those who did not, with benefits persisting after PSM analysis. Multivariate Cox regression identified curative therapy as an independent predictor of OS (hazard ratio HR 0.398; 95% confidence interval CI 0.179-0.885; p = 0.024). CONCLUSIONS: In selected patients with advanced HCC who achieved disease control after atezolizumab-bevacizumab, conversion curative therapy was associated with favorable survival outcomes.
Chen et al. (2026) studied this question.