Statins and clinical outcomes in patients with advanced hepatocellular carcinoma treated with Atezolizumab plus Bevacizumab

The impact of statins on patients receiving immune checkpoint inhibitors for advanced hepatocellular carcinoma (aHCC) remains unclear. This study aimed to evaluate whether statins influence overall survival (OS) and progression-free survival (PFS) in aHCC patients receiving Atezolizumab + Bevacizumab (A + B). ARTE is a prospectively maintained dataset of 305 aHCC patients treated with A + B. Among these, 63 patients receiving statins were identified and propensity score-matched to 63 non-statin users. Primary outcomes were OS and PFS, while treatment discontinuation due to liver-related events was assessed as a secondary outcome. The median treatment duration was 6.4 months (IQR 2.7–13.2). Among the 126 matched patients, viral etiology was the most common (44.4%), followed by metabolic dysfunction-associated steatotic liver disease (MASLD) (40.5%). Median OS was 23 months [95% CI 17.2–28.7] in statin users vs. 16 months [95% CI 12.8–19.2] in non-users, while median PFS was 12 months [95% CI 4.1–19.9] in statin users vs. 8 months [95% CI 4.0–12.0] in non-users, with no significant differences between groups. In multivariate Cox regression, MASLD-induced HCC was associated with a higher risk of progression or death (HR 1.68, 95% CI 1.03–2.75). Statins did not reduce the risk of treatment discontinuation due to liver-related events (HR 1.05, 95% CI 0.27–4.14). Statins did not improve OS or PFS, nor did they reduce the risk of treatment discontinuation due to liver-related events in aHCC patients receiving A + B. Notably, MASLD-related HCC exhibited worse PFS, suggesting a potential differential response to systemic therapies, which warrants further investigation.