Impact of liver function on survival outcomes in patients (pts) treated with first-line atezolizumab-bevacizumab (Atezo-Bev) for unresectable hepatocellular carcinoma (uHCC): Asia-Pacific multicenter retrospective analysis.

509 Background: Atezo-Bev is the established first-line therapy for uHCC, but pivotal trials included only pts with preserved liver function. As pts with impaired liver function are common in daily practice, we retrospectively assessed the prognostic impact of Child-Pugh (CP) score and Albumin-Bilirubin (ALBI) grade on outcomes with first-line Atezo-Bev. Methods: This multinational, multicenter retrospective study included pts with uHCC who received first-line Atezo-Bev at five institutions in Korea, Hong Kong, Taiwan, and Singapore between July 2016 and March 2025. Pts with CP-C class were excluded. Results: A total of 831 pts were included: median 64 year-old; 84% male; BCLC stage A/B/C, 0.5%/19%/80%, CP-A/B 90%/10%, and ALBI grade 1/2/3 41.4%/ 56.1%/2.4%. Compared with CP-A, CP-B pts had numerically lower ORR (25.4% vs 16.3%, p=0.076) and significantly shorter PFS (median 6.1 vs. 2.7 mo, HR 0.54 95% CI, 0.42 to 0.70; p<0.001) and OS (median 18.5 vs. 5.3 mo, HR 0.35 95% CI, 0.27 to 0.45; p<0.001). Among CP-B pts, outcomes did not differ by CP score (median PFS 2.6-3.3 mo, p=0.31; median OS 4.9-5.5 mo, p=0.31). Compared with ALBI grade 1 pts, grade 2 and 3 pts showed similar ORR (24.1%, 25.1%, and 20.0%, p=0.884); but worse median PFS (5.0 and 2.6 vs 6.9 mo; HR 1.33 and 2.20; p<0.001) and OS (12.5 and 4.7 vs 23.1 mo; HR 1.75 and 5.12; p<0.001). Both CP and ALBI remained significant in the multivariable analysis for survival outcomes. Conclusions: Liver function is a key prognostic factor in uHCC pts treated with Atezo-Bev. These data may serve as a benchmark for future clinical trials including pts with impaired liver function.