阿妥珠单抗联合贝伐单抗（Atezo/Bev）是无法切除的肝细胞癌（HCC）的一线治疗方法。体重指数（BMI）在非-HCC癌症类型的免疫治疗反应中已经证明具有预测价值。我们的研究调查了BMI对Atezo/Bev用于无法切除HCC患者的真实世界安全性和疗效的影响。本回顾性研究纳入了来自七个中心接受Atezo/Bev治疗的191位连续患者。测试了超重（BMI≥25）和非超重（BMI＜25）的患者的总生存期（OS）、无进展生存期（PFS）、总体答复率（ORR）和根据RECIST v1.1定义的疾病控制率（DCR）。评估了与治疗相关的不良事件（trAEs）。超重组的患者（n = 94）与非超重组的患者（n = 97）相比，非酒精性脂肪性肝病（NAFLD）的发病率更高，乙肝的发病率更低。两组基线Child-Pugh分级和巴塞罗那肝癌临床分期相似，在超重组中，外肝转移的发生率较低。超重患者的OS与非超重组相似（中位OS为15.1个月对14.9个月；p = 0.99）。BMI不影响中位PFS（7.1个月对6.1个月；p = 0.42）、ORR（27.2％对22.0％；p = 0.44）和DCR（74.1％对71.9％；p = 0.46）。超重患者的阿妥珠单抗相关疲劳（22.3％对10.3％；p = 0.02）和贝伐单抗相关血栓形成（8.5％对2.1％；p = 0.045）的发生率更高，但两组患者的总不良事件和治疗停药率相当。Atezo/Bev在超重HCC患者中具有可比性的疗效，在治疗相关疲劳和血栓形成方面有所增加。联合治疗在超重患者中使用是安全和有效的，包括那些患有基础NAFLD的患者。 © 2023年作者。

Atezolizumab plus bevacizumab (Atezo/Bev) is first line-treatment for unresectable hepatocellular carcinoma (HCC). Body mass index (BMI) has demonstrated predictive value for response to immunotherapy in non-HCC cancer types. Our study investigated the effect of BMI on safety and efficacy of real-life use of Atezo/Bev for unresectable HCC.191 consecutive patients from seven centres receiving Atezo/Bev were included in the retrospective study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in overweight (BMI ≥ 25) and non-overweight (BMI < 25) patients. Treatment-related adverse events (trAEs) were evaluated.Patients in the overweight cohort (n = 94) had higher rates of non-alcoholic fatty liver disease (NAFLD) and lower rates of Hepatitis B compared to non-overweight cohort (n = 97). Baseline Child-Pugh class and Barcelona Clinic Liver Cancer stage were similar between cohorts, with lower rates of extrahepatic spread in the overweight group. Overweight patients had similar OS compared to non-overweight (median OS 15.1 vs. 14.9 months; p = 0.99). BMI did not influence median PFS (7.1 vs. 6.1 months; p = 0.42), ORR (27.2% vs. 22.0%; p = 0.44) and DCR (74.1% vs. 71.9%; p = 0.46). There were higher rates of atezolizumab-related fatigue (22.3% vs. 10.3%; p = 0.02) and bevacizumab-related thrombosis (8.5% vs. 2.1%; p = 0.045) in the overweight patients, but overall trAEs and treatment discontinuation were comparable between cohorts.Atezo/Bev has comparable efficacy in overweight HCC patients, with an increase in treatment-related fatigue and thrombosis. Combination therapy is safe and efficacious to use in overweight patients, including those with underlying NAFLD.© 2023. The Author(s).