Author information

¹Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy.

²Vita-Salute San Raffaele University, Milan, Italy.

³Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

⁴Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

⁵Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan.

⁶Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.

⁷Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan.

⁸Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Higashi-osaka, Japan.

⁹Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.

¹⁰Department of Oncology, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

¹¹Liver Unit-CHTMAD, Vila Real, Portugal.

¹²University Hospital of Pisa, Pisa, Italy.

¹³Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.

¹⁴Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

¹⁵Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.

¹⁶Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

¹⁷Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy.

¹⁸Department of Oncology and Palliative Care, Cardinale G Panico, Tricase City Hospital, Tricase, Italy.

¹⁹Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.

²⁰Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.

²¹Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.

²²Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.

²³Department of Gastroenterology, Okayama City Hospital, Okayama, Japan.

²⁴Department of Gastroenterology and Hepatology, Kagawa University, Takamatsu, Kagawa, Japan.

²⁵Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.

²⁶Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.

²⁷Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.

²⁸Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan.

²⁹Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.

³⁰Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan.

³¹Department of Gastroenterology, Toyama University Hospital, Toyama, Japan.

³²Hepato-biliary Center, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan.

³³Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.

³⁴Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan.

³⁵Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan.

³⁶Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan.

³⁷Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.

³⁸Division of Gastroenterology and Hepatology, Otakanomori Hospital, Kashiwa, Japan.

³⁹Department of Hepatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.

⁴⁰Department of Surgery, Kansai Medical University, Osaka, Japan.

⁴¹Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.

⁴²Medical Oncology, University and University Hospital of Cagliari, Cagliari, Italy.

⁴³Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy.

Abstract

Introduction: Overweight is a negative prognostic factor in the general population in the long term. However, the role of body mass index (BMI) in the short-mid term in advanced tumours is unclear. The present analysis investigates the role of BMI weight classes in a large sample of patients affected by HCC and receiving atezolizumab plus bevacizumab or lenvatinib as first-line treatment.

Methods and material: The cohort included consecutive patients affected by BCLC-c and BCLC-B HCC patients from a multicenter international study group who received atezolizumab plus bevacizumab or lenvatinib as first-line therapy. Population was stratified according to the BMI in under-, over- and normal-weight according to the conventional thresholds. The primary objective of the study was to evaluate the prognostic and predictive impact of BMI in patients affected by advanced or intermediate HCC. Survival curves were estimated using the product-limit method of Kaplan-Meier. The role of stratification factors was analysed with log-rank tests.

Results: 1292 consecutive patients with HCC were analysed. 466 (36%) patients were treated with lenvatinib and 826 (64%) patients were treated with atezolizumab plus bevacizumab. In the atezolizumab plus bevacizumab arm, 510 (62%) patients were normal-weight, 52 (6%) underweight and 264 (32%) overweight. At the univariate analysis for OS, underweight patients had significantly shorter OS compared to normal-weight patients, whereas no differences were found between normal-weight versus overweight. Multivariate analysis confirmed that underweight patients had significantly shorter OS compared to normal-weight patients (HR: 1.7; 95% CI: 1.0-2.8; p = .0323). In the lenvatinib arm, 26 patients (5.6%) were categorized as underweight, 256 (54.9%) as normal-weight, and 184 (39.5%) as overweight. At the univariate analysis for OS, no significant differences were found between normal-weight versus underweight and between normal-weight versus overweight, which was confirmed at multivariate analysis.

Conclusion: Our analysis highlighted a prognostic role of BMI in a cohort of patients with advanced HCC who received atezolizumab plus bevacizumab, while no prognostic role for low BMI was apparent in patients who received lenvatinib.