Background:Atezolizumab plus bevacizumab (Atezo + Bev) is the standard of care for treatment-naïve patients with unresectable hepatocellular carcinoma (uHCC). Proteinuria is a treatment-emergent adverse event that often leads to Bev interruption. However, the relationship between Bev-related proteinuria and renal dysfunction is unclear. We retrospectively investigated the impact of proteinuria after starting Atezo + Bev on renal function in patients with uHCC.Methods:We performed a single-arm retrospective study of patients with uHCC treated with Atezo + Bev between 25 September 2020 and 31 May 2022, at Kindai University Hospital, Japan. The impact of proteinuria on renal function during Atezo + Bev treatment was analyzed in terms of the correlation between changes in urine protein creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR) relative to baseline.Results:We analyzed data from 100 patients (median age 74 years; range 41–89; 75% male). During Atezo + Bev treatment, the median (interquartile range) maximum increase from baseline in UPCR was 0.39 (0.08 to 2.05) and the median maximum decline from baseline in eGFR was −7.5 (−20.5 to −3.0) mL/min/1.73 m2. The Pearson and Spearman correlation coefficients (95% confidence intervals) between these variables were −0.16 (−0.34 to 0.04) and −0.13 (−0.32 to 0.07), respectively.Conclusions:We found no correlation between the changes in UPCR and eGFR during Atezo + Bev treatment. Bev interruption criteria are based on the degree of proteinuria; however, our results suggest that proteinuria does not necessarily impair renal function. Physicians should consider the risk–benefit profile when deciding whether to discontinue Bev in patients who develop proteinuria during Atezo + Bev treatment.
背景：阿替利珠单抗联合贝伐珠单抗（Atezo + Bev）是治疗初治不可切除肝细胞癌（uHCC）的标准方案。蛋白尿是该方案治疗中出现的不良事件，常导致贝伐珠单抗治疗中断。然而，贝伐珠单抗相关蛋白尿与肾功能障碍之间的关系尚不明确。本研究回顾性探讨了uHCC患者开始Atezo + Bev治疗后出现蛋白尿对肾功能的影响。 方法：我们在日本近畿大学医院开展了一项单臂回顾性研究，纳入2020年9月25日至2022年5月31日期间接受Atezo + Bev治疗的uHCC患者。通过分析尿蛋白肌酐比值（UPCR）变化与估算肾小球滤过率（eGFR）相对于基线的变化之间的相关性，评估Atezo + Bev治疗期间蛋白尿对肾功能的影响。 结果：我们分析了100例患者的数据（中位年龄74岁，范围41-89岁；75%为男性）。在Atezo + Bev治疗期间，UPCR相对于基线的最大升幅中位数（四分位距）为0.39（0.08至2.05），eGFR相对于基线的最大降幅中位数为-7.5（-20.5至-3.0）mL/min/1.73 m²。这两个变量之间的皮尔逊相关系数（95%置信区间）和斯皮尔曼相关系数（95%置信区间）分别为-0.16（-0.34至0.04）和-0.13（-0.32至0.07）。 结论：我们发现Atezo + Bev治疗期间UPCR变化与eGFR变化无相关性。贝伐珠单抗的停药标准基于蛋白尿程度；然而，我们的结果表明蛋白尿并不一定会损害肾功能。对于在Atezo + Bev治疗期间出现蛋白尿的患者，临床医生在决定是否停用贝伐珠单抗时，应综合考虑风险与获益。
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