The Low Platelet Count at the Start of Atezolizumab Plus Bevacizumab Therapy for Unresectable Hepatocellular Carcinoma Predicts Deteriorated Liver Function at the Time of Disease Progression Thereafter: A Multicenter Analysis

Background There are few reports on the factors that contribute to liver function at the time of disease progression after first‐line systemic therapy for unresectable hepatocellular carcinoma (u‐HCC). Therefore, our multicenter study investigated these factors in u‐HCC patients treated with atezolizumab plus bevacizumab (ATZ/BEV). Methods We enrolled 101 patients with u‐HCC who had preserved liver function, Child–Pugh (CP) Class A at baseline, and were treated with ATZ/BEV as the first‐line systemic chemotherapy. All were evaluated for progressive disease (PD) during the observational period, and those who had Child–Pugh Class A at evaluation of PD were classified as Group A, with those who had Child–Pugh Class B at evaluation of PD being classified as Group B. Results Comparing the two groups, Group A had significantly higher platelet counts than Group B ( p = 0.008). Receiver operating characteristic curve analysis for differentiating CP Class A versus B at the time of evaluation of PD, using platelet counts, showed that the area under the curve was 0.690 and the optimal cutoff value was 12.8 × 10 4 /μL. Multivariate analysis showed that only the low platelet count was associated with CP Class B at the time of evaluation of PD (< 12.8/≥ 12.8 × 10 4 /μL: OR 3.780, p = 0.022). Conclusions The data suggest that the platelet count can be used to predict liver function at the time of evaluation of PD after ATZ/BEV therapy in patients with u‐HCC. Treatment strategies in u‐HCC patients with low platelet counts should be conducted by taking into account deterioration of liver function after ATZ/BEV therapy.