Abstract
AIM: Systemic therapy for advanced hepatocellular carcinoma (HCC) includes multi-kinase inhibitors with anti-vascular endothelial growth factor (VEGF) activity and anti-VEGF monoclonal antibodies in combination with immune checkpoint inhibitors. This study aimed to investigate and compare the chronological changes in liver volume between patients who received atezolizumab plus bevacizumab (Atezo/Bev) and those who received lenvatinib. METHODS: We enrolled patients who received initial treatment with either Atezo/Bev or lenvatinib for advanced HCC between October 2018 and May 2023. Patients underwent periodic computed tomography (CT) or magnetic resonance imaging (MRI) to evaluate systemic therapy effects. Patients with portal vein thrombosis or prior liver resection/transplantation were excluded. Liver volume was measured at baseline and at 8 and 16 weeks after the initiation of treatment using commercially available software. Liver volume at each time point was expressed as a proportion relative to baseline. A linear regression analysis was used to analyze the chronological changes in liver volume. RESULTS: Seventy-three patients (40 in the Atezo/Bev group and 33 in the lenvatinib group) were included in this retrospective study. Liver volume decreased in 54 patients (74%) at week 8; the average volume relative to baseline was 0.92 (95% confidence interval: 0.90-0.94, p < 0.01). Liver volume decreased in patients with both shrinking and enlarged tumors. Multivariate analysis indicates that the decrease in nontumoral liver volume was more significant in the lenvatinib group than in the Atezo/Bev group (p = 0.04). CONCLUSIONS: Anti-angiogenic therapy for advanced HCC can lead to liver atrophy.