Impact of body mass index on the prognosis of unresectable HCC patients receiving first‐line Lenvatinib or atezolizumab plus bevacizumab
Authors: Rimini Margherita , Stefanini Bernardo , Tada Toshifumi , Suda Goki , Shimose Shigeo , Kudo Masatoshi , Finkelmeier Fabian , Yoo Changhoon , Presa José , Amadeo Elisabeth , genovesi Virginia , De Grandis Maria Caterina , Iavarone Massimo , Marra Fabio , Foschi Francesco , Tamburini Emiliano , Rossari Federico , Vitiello Francesco , Bartalini Linda , Soldà Caterina , Tovoli Francesco , Vivaldi Caterina , Lonardi Sara , Silletta Marianna , Kumada Takashi , Sakamoto Naoya , Iwamoto Hideki , Aoki Tomoko , Himmelsbach Vera , Montes Margarida , Hiraoka Atsushi , Sho Takuya , Niizeki Takashi , Nishida Naoshi , Steup Christoph , Hirooka Masashi , Kariyama Kazuya , Tani Joji , Atsukawa Masanori , Takaguchi Koichi , Itobayashi Ei , Fukunishi Shinya , Tsuji Kunihiko , Ishikawa Toru , Tajiri Kazuto , Ochi Hironori , Yasuda Satoshi , Toyoda Hidenori , Ogawa Chikara , Nishimura Takashi , Hatanaka Takeshi , Kakizaki Satoru , Shimada Noritomo , Kawata Kazuhito , Tada Fujimasa , Ohama Hideko , Nouso Kazuhiro , Morishita Asahiro , Tsutsui Akemi , Nagano Takuya , Itokawa Norio , Okubo Tomomi , Arai Taeang , Imai Michitaka , Kosaka Hisashi , Naganuma Atsushi , Koizumi Yohei , Nakamura Shinichiro , Kaibori Masaki , Iijima Hiroko , Hiasa Yoichi , Persano Mara , Camera Silvia , Foti Silvia , Aldrighetti Luca , Cascinu Stefano , Casadei‐Gardini Andrea , Piscaglia Fabio 
Published: March 2024

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.