Real-World Survival Outcomes of Atezolizumab and Bevacizumab in Unresectable Hepatocellular Carcinoma Patients With Hepatitis B Virus Infection: A Hospital-Based Cohort Study

Background Atezolizumab-Bevacizumab is one of the standard treatment for unresectable hepatocellular carcinoma patients. However, clinical data on the effectiveness of this regimen specifically in patients with HBV–related unresectable hepatocellular carcinoma remain limited . Objectives To evaluate survival outcomes and identify prognostic factors in HBV-infected unresectable HCC patients treated with Atezolizumab-Bevacizumab as first line systemic therapy. Methods A prospective combining retrospective cohort study, conducted on unresectable HCC patients with HBV infection, treated with Atezolizumab-Bevacizumab as the first-line systemic therapy at 3 major cancer-specialized hospitals in Northern Vietnam from June 2020 to August 2024. Results Totally 97 patients were included, the median age was 57 years, 89.4% were male. After a median follow-up of 11.1 (95% CI: 9.8-13.2) months, the median progression-free survival (mPFS) was 4.3 (95% CI: 3.4-5.2) months, and the median overall survival (mOS) was 20 (95% CI: 11.1-28.9) months. Multivariate analysis showed that Child-Pugh score A 6 points and B 7-8 points (HR: 2.0, P = 0.009 and HR: 4.5, P = 0.029), liver tumor size ≥80 mm (HR: 1.7, P = 0.037), and distant metastasis (HR: 1.9, P = 0.019), were independent predictors of PFS. Independent predictors of OS included ECOG - PS 1 (HR: 1.8, P = 0.047), ALBI grade 2-3 (HR: 2.0, P = 0.033), and NLR >2.9 (HR: 2.0, P = 0.023). Conclusion The Atezolizumab-Bevacizumab regimen has shown favorable effectiveness as first-line treatment for unresectable HBV-related HCC in Vietnam. These findings provide real-world evidence to support policymakers in developing treatment strategies in HBV-endemic regions and guide future research on optimizing HCC management.