Survival Outcomes and Prognostic Factors of Systemic Therapy for Advanced Hepatocellular Carcinoma: A Multidisciplinary Clinic Experience from Saudi Arabia.

PURPOSE

To investigate survival outcomes and prognostic factors of systemic therapies in advanced hepatocellular carcinoma (HCC) within Saudi Arabia, addressing the limited regional data.

PATIENTS AND METHODS

A retrospective review of 670 HCC patients was utilized. 130 patients with advanced HCC who received first-line systemic therapy were identified, and data on demographics, tumor characteristics, treatment regimens, laboratory findings, and survival outcomes were collected. Treatment response and survival outcomes were evaluated using RECIST criteria and the Kaplan-Meier method, respectively.

RESULTS

Our population's mean age was 70.4, majority being males. Sorafenib was the most frequently used, then nivolumab and the atezolizumab-bevacizumab (Atezo+Bev) combination. Median overall survival (OS) varied by treatment: patients receiving Atezo+Bev showed the longest OS, followed by nivolumab and sorafenib. No statistically significant difference was observed in survival. Despite the small sample size, this trend suggests a potential OS benefit with Atezo+Bev, particularly in patients with advanced hepatic dysfunction. Furthermore, 39.1% of patients had elevated alpha-fetoprotein (AFP) levels and 26.8% had sarcopenia. Multivariate analysis highlighted the elevated neutrophil-to-lymphocyte ratio (NLR) as a significant predictor of worse survival, reinforcing its relevance as a prognostic marker in HCC. Although sarcopenia demonstrated an improved survival trend, it was not statistically significant. Adverse events were consistent, with elevated AST, anorexia, and fatigue frequently observed.

CONCLUSION

This study illustrated Atezo+Bev's potential in improving OS in advanced HCC, with an elevated NLR identified as a key marker for poor prognosis. These findings support the need for prospective studies to confirm and expand regional insights into the management of HCC.