Statin Use Is Associated With Improved Survival But Not Progression‐Free Outcomes in Patients With Unresectable Hepatocellular Carcinoma Receiving Atezolizumab–Bevacizumab

AIM: Statins contribute to the preservation of hepatic function and reduce the risk of hepatocellular carcinoma (HCC) in patients with chronic liver disease; however, their clinical significance during systemic therapy for unresectable HCC remains unclear. Therefore, we investigated whether baseline statin use influences clinical outcomes in patients with unresectable HCC treated with atezolizumab plus bevacizumab. METHODS: We conducted a multicenter, retrospective cohort study of patients with unresectable HCC treated with atezolizumab-bevacizumab. Patients were classified as statin users or non-users at treatment initiation. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS) and post-progression survival (PPS). To adjust for baseline imbalances, inverse probability of treatment weighting (IPTW) was applied, and propensity score (PS) matching was performed as a sensitivity analysis. RESULTS: A total of 284 patients were included, of whom 50 received statins. In the unadjusted cohort, OS was significantly longer in statin users than in non-users (p = 0.026). After IPTW adjustment, this OS benefit remained significant (p = 0.031). In contrast, PFS did not differ significantly between groups in either the unadjusted (p = 0.291) or IPTW-adjusted cohorts (p = 0.117). PPS was significantly prolonged in the statin group (p = 0.006), with consistent findings after IPTW adjustment (p = 0.018). In addition, deterioration in ALBI score was attenuated in statin users, suggesting better preservation of hepatic functional reserve. CONCLUSIONS: Statin use was associated with significantly improved OS and PPS without affecting PFS, likely reflecting host-related benefits through preservation of hepatic function.