Background/Objectives: Management of hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) varies between systemic immunotherapy and locoregional approaches. We compared atezolizumab plus bevacizumab (Atezo–Bev) with locoregional therapy in treatment-naïve patients.Methods: We conducted a retrospective cohort study of patients with image- or biopsy-proven HCC and MVI, Child–Pugh A/B, and ECOG 0–1 who received first-line Atezo–Bev or locoregional therapy (transarterial chemoembolization [TACE] with or without external-beam radiotherapy [RT]). Inverse probability of treatment weighting (IPTW) minimized baseline imbalances. Primary outcomes were overall survival (OS) and progression-free survival (PFS). Modified RECIST assessed radiologic response, and major adverse events were classified using Society of Interventional Radiology criteria.Results: We analyzed 475 patients (Atezo–Bev,n= 191; locoregional therapy,n= 284). Baseline characteristics were similar, and IPTW achieved covariate balance. Median OS was 9.3 months with Atezo–Bev and 10.8 months with locoregional therapy; after IPTW, OS remained comparable (hazard ratio [HR] 0.95; 95% CI 0.76–1.19;p= 0.635). Median PFS was 6.0 versus 4.1 months, favoring Atezo–Bev; this persisted after IPTW (HR 0.64; 95% CI 0.52–0.79;p< 0.001). Objective response rates were similar (45% vs. 48%;p= 0.49). Major adverse events occurred in 11% of patients in both groups. Subgroup analyses showed no OS differences and a consistent PFS advantage with Atezo–Bev.Conclusions: In HCC with MVI, first-line Atezo–Bev achieved longer PFS than locoregional therapy, with comparable OS and safety, supporting Atezo–Bev as a valid and effective first-line option for disease control while locoregional modalities remain relevant within multidisciplinary care.
背景/目的：针对伴有大血管侵犯（MVI）的肝细胞癌（HCC），临床治疗策略在系统性免疫治疗与局部区域治疗之间存在差异。本研究比较了阿替利珠单抗联合贝伐珠单抗（Atezo–Bev）与局部区域治疗在初治患者中的疗效。 方法：本研究为回顾性队列研究，纳入经影像或活检证实为HCC伴MVI、Child–Pugh分级A/B级、ECOG评分0–1分且接受一线Atezo–Bev或局部区域治疗（经动脉化疗栓塞[TACE]联合或不联合外照射放疗[RT]）的患者。采用逆概率处理加权法（IPTW）以平衡基线差异。主要结局指标为总生存期（OS）和无进展生存期（PFS）。采用改良RECIST标准评估影像学反应，主要不良事件依据介入放射学会标准进行分类。 结果：共分析475例患者（Atezo–Bev组191例；局部区域治疗组284例）。基线特征相似，IPTW后协变量达到平衡。Atezo–Bev组中位OS为9.3个月，局部区域治疗组为10.8个月；IPTW调整后OS仍相当（风险比[HR] 0.95；95% CI 0.76–1.19；p=0.635）。中位PFS分别为6.0个月与4.1个月，Atezo–Bev组更优；IPTW后该优势持续存在（HR 0.64；95% CI 0.52–0.79；p<0.001）。客观缓解率相近（45% vs. 48%；p=0.49）。两组主要不良事件发生率均为11%。亚组分析显示OS无差异，且Atezo–Bev的PFS优势具有一致性。 结论：在伴有MVI的HCC患者中，一线Atezo–Bev治疗相较于局部区域治疗可获得更长的PFS，且OS与安全性相当。这支持Atezo–Bev作为疾病控制的有效一线选择，而局部区域治疗在多学科综合治疗中仍具重要价值。
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