Introduction The purpose of this study was to investigate the incidence, risk factors, and prognostic significance of intratumoral hemorrhage (ITH) in patients with hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (A+B) therapy. Methods In this single‑center retrospective cohort, 107 consecutive patients with HCC received A+B between October 2020 and March 2022 and underwent contrast‑enhanced CT before and after therapy initiation. ITH was defined on the arterial phase of the first follow‑up CT as intratumoral contrast pooling with a surrounding low‑attenuation rim absent on non‑contrast images. When present, foci were counted and graded (1-4); maximum tumor diameter was measured on portal‑venous phase images. Progression‑free survival (PFS) from treatment start to progression or death was analyzed per RECIST 1.1 and modified RECIST (mRECIST). Results On the first follow up CT, ITH was observed in 12 of 107 patients (11.2%). Patients with ITH had larger tumors than those without (p=0.002). ITH was confined to the tumor; no intraperitoneal hemorrhage occurred. Among nine patients with serial CTs, ITH grade decreased during follow up in seven (77.8%). Thereafter, A+B was discontinued for progressive disease (PD) in five of these cases. PFS did not differ between patients with and without ITH by RECIST 1.1 or mRECIST (p=0.74 and 0.98, respectively). Conclusion ITH was an early, on‑treatment radiologic finding during A+B therapy for HCC and was more frequent in larger tumors. In this cohort, ITH was not associated with a statistically significant difference in PFS. Among patients with serial CT examinations, ITH grade decreased during follow-up in most evaluable cases; however, the clinical significance of this temporal change remains to be determined. No hemoperitoneum was observed, supporting careful observation in the absence of overt hemorrhage.
Takeuchi et al. (Tue,) studied this question.