ArticleSurgery today2026
Early thyroid-stimulating hormone dynamics predict outcomes in advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab.
Article in Surgery today, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEarly predictive biomarkers for response to atezolizumab plus bevacizumab (Atez+Bev) in advanced hepatocellular carcinoma (HCC) remain unclear. We investigated the prognostic significance of early thyroid-stimulating hormone (TSH) dynamics and the aspartate aminotransferase-to-platelet ratio index (APRI) in patients receiving Atez+Bev.
methodsWe retrospectively analyzed 32 patients with advanced HCC treated with Atez+Bev. TSH ratios after 1 and 2 treatment cycles were calculated relative to baseline. Cutoff values were determined using receiver operating characteristic analysis. Progression-free survival (PFS) was evaluated using Kaplan-Meier analysis and Cox proportional hazards models. Landmark analysis was performed to minimize immortal time bias.
resultsThe objective response rate was 25%. Patients with a low TSH ratio after 1 cycle (< 1.23) showed shorter PFS than those with a high ratio. In exploratory multivariable analysis, APRI ≥0.81 (hazard ratio [HR] 3.17, 95% confidence interval [CI] 1.02-9.81, p=0.046) and TSH ratio after 1 cycle <1.23 (HR 2.76, 95% CI 1.01-7.54, p=0.040) were independently associated with shorter PFS. Landmark analysis showed a consistent association between early TSH dynamics and PFS.
conclusionsEarly TSH dynamics and baseline APRI may be useful for exploratory risk stratification in advanced HCC treated with Atez+Bev, although these findings require validation in larger cohorts.
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