Albumin infusion reduces ascite occurrence in Child-Pugh B patients treated by Atezolizumab-Bevacizumab for advanced HCC

Sayma Chaibi; Edouard Larrey; Jean Pierre Couty; Philippe Sultanik; Claudia Campani; Lorraine Blaise; Mathilde Wagner; Chantal Desdouets; Jean Charles Nault; Dominique Thabut; Manon Allaire

doi:10.1016/j.clinre.2023.102199

Albumin infusion reduces ascite occurrence in Child-Pugh B patients treated by Atezolizumab-Bevacizumab for advanced HCC

Clin Res Hepatol Gastroenterol. 2023 Sep 2;47(8):102199. doi: 10.1016/j.clinre.2023.102199. Online ahead of print.

Affiliations

¹ AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France.
² INSERM UMR 1138, Centre de recherche des Cordeliers, 75006, Paris, France.
³ INSERM UMR 1138, Centre de recherche des Cordeliers, 75006, Paris, France; AP-HP Sorbonne Paris Nord, Hôpitaux Universitaire Paris Seine Saint-Denis, Service d'Hépatologie, Bobigny, France.
⁴ AP-HP Sorbonne Paris Nord, Hôpitaux Universitaire Paris Seine Saint-Denis, Service d'Hépatologie, Bobigny, France.
⁵ AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de radiologie diagnostique, Paris, France.
⁶ AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France; Sorbonne Université, INSERM, Centre de recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), F-75012, Paris, France.
⁷ AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France; INSERM UMR 1138, Centre de recherche des Cordeliers, 75006, Paris, France. Electronic address: manon.allaire@aphp.fr.

PMID: 37666414
DOI: 10.1016/j.clinre.2023.102199

Abstract

Background: Long-term albumin infusions have been associated with improved outcomes in decompensated cirrhotic patients. This study aimed to evaluate the impact of albumin infusion on the prognosis of Child-Pugh B patients undergoing treatment with AtezoBev for advanced hepatocellular carcinoma (HCC).

Methods: We conducted a retrospective multicentric study that included all Child-Pugh B cirrhotic patients treated with AtezoBev since 2020. We examined the effects of albumin infusion (40 g every 3 weeks) on overall survival (OS) and the occurrence of cirrhosis-related complications. Time-to-event data were analyzed using Kaplan-Meier with the log-rank test and Cox models.

Results: Forty-seven HCC patients with a Child-Pugh B score who received AtezoBev were included, of whom 26% also received albumin infusions every 3 weeks. The two groups were similar in terms of liver function and HCC parameters. The median OS was 4.4 and 5.8 months (p = 0.42) for patients who did or did not receive albumin, respectively. The occurrence of hepatic encephalopathy and variceal bleeding was similar between the two groups. However, albumin infusions were associated with a significantly lower rate of ascites expansion/development (13% versus 57%, p = 0.005). Cox analysis revealed that a history of ascites (HR=3.82 [95% CI: 1.73-8.48]) was independently associated with a higher risk of ascites expansion/development, whereas albumin infusions were protective (HR=0.07 [95% CI: 0.01-0.54]).

Conclusions: Albumin infusion did not improve overall survival in Child-Pugh B HCC patients treated with AtezoBev, but it significantly reduced the expansion/development of ascites.

Keywords: Albumin; Atezolizumab-Bevacizumab; Hepatocellular carcinoma; Overall survival; prognostic factors.