Recommended treatment options for advanced-stage hepatocellular carcinoma (HCC) include systemic therapy (ST) and trans-arterial radioembolization (TARE) with Yttrium-90 (Y90). Before the approval of immune-checkpoint inhibitors, a similar safety profile was reported for TARE and ST with tyrosine kinase inhibitors (TKI). However, whole-liver treatment and underlying cirrhosis were identified as risk factors for potentially lethal radioembolization-induced liver disease (REILD). Therefore, the safety and efficacy of TARE and ST with atezolizumab/bevacizumab were compared in patients with advanced HCC involving at least both liver lobes in a retrospective real-world cohort. In total, 74 patients with new or recurrent advanced-stage HCC (BCLC stage B/C) were included if treated with either bilobar TARE (n = 33) or systemic combination therapy with atezolizumab plus bevacizumab (n = 41). Most patients had compensated liver function (90.5% were classified as Child-Pugh Score A, 73% as ALBI Grade 1) at baseline. Although not significant, patients treated with ST showed a more prolonged overall survival than those treated with Y90 TARE (7.1 months vs. 13.0 months,p= 0.07). While a similar disease control rate could be achieved with bilobar TARE and atezolizumab/bevacizumab, in the TARE group, overall survival was curtailed by the occurrence of REILD. In patients with underlying liver cirrhosis, the liver function at baseline was a predictor for REILD.
晚期肝细胞癌（HCC）的推荐治疗方案包括全身治疗（ST）和钇-90（Y90）经动脉放射栓塞术（TARE）。在免疫检查点抑制剂获批之前，TARE与酪氨酸激酶抑制剂（TKI）全身治疗的安全性特征相似。然而，全肝治疗和潜在肝硬化被确定为可能导致致命性放射栓塞相关肝病（REILD）的风险因素。因此，本研究在一个回顾性真实世界队列中，比较了TARE与阿特珠单抗/贝伐珠单抗全身治疗在累及至少双肝叶的晚期HCC患者中的安全性和有效性。共纳入74例新发或复发性晚期HCC（BCLC B/C期）患者，分别接受双肝叶TARE治疗（n=33）或阿特珠单抗联合贝伐珠单抗全身治疗（n=41）。基线时大多数患者肝功能代偿良好（90.5%为Child-Pugh A级，73%为ALBI 1级）。尽管差异未达统计学显著性，但接受全身治疗的患者总生存期较Y90 TARE治疗者更长（13.0个月 vs. 7.1个月，p=0.07）。虽然双肝叶TARE与阿特珠单抗/贝伐珠单抗治疗能达到相似的疾病控制率，但TARE组的总生存期因REILD的发生而缩短。在潜在肝硬化患者中，基线肝功能是REILD的预测因素。
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