In this study, we aimed to evaluate the efficacy and safety of atezolizumab plus bevacizumab (Atez/Bev) treatment for unresectable hepatocellular carcinoma (HCC) and to analyze the factors affecting overall survival (OS). A total of 69 patients who received Atez/Bev at our institutions for unresectable HCC were enrolled in this study. OS and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Changes in clinical indicators within 3 months were defined as delta (∆) values, and the Cox proportional hazards model was used to identify which ∆ values affected OS. The median OS, PFS, objective response rate, and disease control rate were 12.5 months, 5.4 months, 23.8%, and 71.4%, respectively. During the observational period, 62 patients (92.5%) experienced AEs (hypertension (33.3%) and general fatigue), and 27 patients (47.4%) experienced grade ≥ 3 AEs (hypertension (10.1%) and anemia (7.2%)). There was a significant deterioration in the albumin-bilirubin (ALBI) score (−2.22 to −1.97; p < 0.001), and a reduction in PIVKA-II levels (32,458 to 11,584 mAU/mL; p = 0.040) within 3 months after commencing Atez/Bev. Both the worsening ∆ ALBI score (p = 0.005) and increasing ∆ PIVKA-II (p = 0.049) were significantly associated with the OS of patients.

This study aimed to assess the effects of lenvatinib (LEN) or sorafenib (SOR) treatment for hepatocellular carcinoma (HCC) on body composition and changes in body composition on survival. This study enrolled 77 HCC patients. Skeletal muscle index (SMI), subcutaneous and visceral adipose tissue indices (SATI and VATI), AFP, PIVKA-II, and ALBI scores were analyzed at the time of LEN/SOR introduction, three months after the introduction, at treatment discontinuation, and the last observational time. The differences between chronological changes in these values were analyzed using a paired t-test. The Cox proportional hazards model was used to analyze prognostic factors using time-varying covariates. The chronological changes in each factor were 45.5–43.6–40.6–39.8 (cm²/m²) for SMI, 41.7–41.6–36.3–33.7 (cm²/m²) for SATI, 41.9–41.1–37.1–34.8 (cm²/m²) for VATI, 2.379–26.42–33.61–36.32 (×10³ ng/mL) for AFP, 9.404–13.39–61.34–25.70 (×10³ mAU/mL) for PIVKA-II, and −2.56–−2.38–−1.99–−1.90 for the ALBI score. The presence of pre-treatment (p = 0.042), AFP (p = 0.002), PIVKA-II (p < 0.001), ALBI score (p < 0.001), and SMI (p = 0.001) were independent prognostic factors. Skeletal muscle mass decreases significantly during LEN/SOR treatment and is an independent prognostic factor for HCC.

This study aimed to investigate the association between vitamin D deficiency and covert hepatic encephalopathy (CHE), overt hepatic encephalopathy (OHE) occurrence, and mortality in patients with cirrhosis. This retrospective study reviewed 679 patients with cirrhosis. Vitamin D deficiency was defined as serum 25-hydorxyvitamin D (25-OHD) levels < 20 ng/mL. The associations between 25-OHD and CHE, OHE occurrence, and mortality were assessed using logistic regression, Fine-Gray competing risk regression, and Cox proportional hazards regression models, respectively. Of 428 eligible patients, 75% had vitamin D deficiency and 23% had CHE. The prevalence of CHE was higher in patients with vitamin D deficiency than in those without vitamin D deficiency (28% vs. 13%, p = 0.002). During the median follow-up period of 2.3 years, 14% of the patients developed OHE and 27% died. Patients with vitamin D deficiency had a higher incidence of OHE (p = 0.002) and mortality (p = 0.006) than those without vitamin D deficiency. After adjustment for potential covariates, multivariate analyses showed that 25-OHE was associated with CHE (odds ratio, 0.95; 95% confidence interval [CI], 0.91-0.99; p = 0.023), OHE occurrence (sub-distribution hazard ratio, 0.92; 95% CI, 0.86-0.98; p = 0.013) and mortality (hazard ratio, 0.96; 95% CI, 0.93-0.99; p = 0.020) in patients with cirrhosis. Vitamin D deficiency is highly prevalent and is associated with CHE, OHE, and mortality in patients with cirrhosis. Evaluation of vitamin D is essential to predict the outcomes of patients with cirrhosis.

Background: This study aimed to investigate the usefulness of the psoas muscle index (PMI) as an independent predictor of survival after systemic targeted therapy initiation in patients with hepatocellular carcinoma (HCC). Method: In total, 214 patients with HCC who underwent systemic targeted therapy at the Gifu University Hospital were enrolled. The correlation between the PMI and the skeletal muscle index (SMI) was assessed using Pearson’s correlation coefficient (PCC). The Cox proportional hazards model was employed to determine whether the PMI, along with the α-fetoprotein (AFP) level and the ALBI score, influenced survival; these variables were considered time-dependent covariates. The optimal PMI cut-off value that yielded the most significant differences in survival was determined using maximally selected statistics. Results: The PMI was significantly correlated with the SMI (PCC = 0.38 and p < 0.001 for women; PCC = 0.62 and p < 0.001 for men). The PMI independently influenced survival (hazard ratio: 0.852; 95% confidence interval: 0.755–0.962; and p < 0.001), along with established prognostic factors such as the AFP and the ALBI score. The optimal PMI cut-off values that yielded the most significant differences in survival were 2.86 cm²/m² for women and 3.55 cm²/m² for men, and these values significantly stratified patient outcomes for both sexes (p < 0.001). Conclusions: The PMI serves as a reliable surrogate for the SMI in assessing skeletal muscle mass and predicting survival.

This study aimed to evaluate chronological changes in skeletal muscle index (SMI), subcutaneous and visceral adipose tissue indices (SATI and VATI), AFP, PIVKA-II, and ALBI scores during atezolizumab plus bevacizumab (AB) or lenvatinib (LEN) treatment for hepatocellular carcinoma (HCC) and the effect of these changes on survival. A total of 94 patients with HCC (37 were on AB and 57 on LEN) were enrolled. SMI, SATI, VATI, AFP, PIVKA-II, and ALBI scores were analyzed at the time of the treatment introduction (Intro), 3 months after the introduction (3M), at drug discontinuation (End), and the last observational time (Last). The differences between chronological changes were analyzed using the Wilcoxon paired test. The independent predictors for survival and the changes in SMI during AB or LEN (c-SMI%) were analyzed using the Cox proportional hazards model treating all these factors as time-varying covariates and the analysis of covariance, respectively. SMI in the AB group was maintained over time (42.9–44.0–40.6–44.2 cm²/m²), whereas that in the LEN group significantly decreased during the Intro–3M (p < 0.05) and 3M–End (p < 0.05) period (46.5–45.1–42.8–42.1 cm²/m²). SMI (p < 0.001) was an independent predictor for survival together with AFP (p = 0.004) and ALBI score (p < 0.001). Drug choice (AB or LEN; p = 0.038) and PIVKA-II (p < 0.001) were extracted as independent predictors for c-SMI%. AB treatment was significantly superior to LEN in terms of maintaining skeletal muscle, which is an independent predictor for survival.

This study aimed to investigate the prevalence and prognostic impact of cachexia in patients with unresectable hepatocellular carcinoma (HCC) receiving systemic targeted therapy. This single-center retrospective study included patients with HCC who underwent systemic targeted therapy. Cachexia was defined using novel criteria proposed in 2023. The prognostic impact of cachexia was evaluated using the Cox proportional hazards model. Of the 200 patients (160 males [80%]; median age, 73 years), cachexia was identified in 70 patients and associated with higher des-gamma-carboxy prothrombin levels, and extrahepatic spread. Patients with cachexia had significantly shorter overall survival (OS) (median 14.1 vs. 20.9 months, p = 0.002) and post-progression survival (PPS) (4.8 vs. 11.1 months, p = 0.001) compared to patients without cachexia. Multivariable analyses revealed cachexia as an independent adverse factor for OS (hazard ratio 1.54; 95% confidence interval 1.03-2.30, p = 0.035) and PPS (hazard ratio 1.64; 95% confidence interval 1.08-2.47, p = 0.018). No significant differences were observed in Progression-free survival between the two groups. Treatment discontinuation due to general appearance deterioration was more common in cachectic patients. Cachexia was prevalent among patients with HCC receiving systemic targeted therapy and was identified as an independent predictor of poorer OS and PPS. Given the prognostic impact, the evaluation of cachexia is crucial in managing patients with HCC undergoing systemic targeted therapy.