Introduction The combination of atezolizumab/bevacizumab has emerged as an effective first-line treatment for advanced hepatocellular carcinoma (HCC). However, this therapy is potentially associated with bleeding complications, warranting a comprehensive analysis of their incidence and severity. This meta-analysis aims to synthesize available evidence from clinical trials and observational studies to quantify the prevalence of bleeding following atezolizumab/bevacizumab administration. Methods This meta-analysis focused on HCC treatment using atezolizumab/bevacizumab, particularly examining bleeding complications. It determined the prevalence of bleeding post-administration and compared the risk ratio with tyrosine kinase inhibitors (sorafenib or lenvatinib). Risk factors for bleeding complications were also evaluated. Results From 28 studies involving 3,895 patients, the pooled prevalence of bleeding side effects was 8.42% (95% CI: 5.72-11.54). Grade III or IV bleeding occurred in 4.42% (95% CI: 2.64-6.10) of patients, with grade V bleeding observed in 2.06% (95% CI: 0.56-4.22). Gastrointestinal bleeding, predominantly variceal, was the most common, with a prevalence of 5.48% (95% CI: 3.98-7.17). Subgroup analysis indicated variability in bleeding rates based on study design and geographical location. Atezolizumab/bevacizumab treatment exhibited a 2.11 times higher prevalence of bleeding compared to tyrosine kinase inhibitors (95% CI: 1.21-3.66). Meta-regression identified high body mass index (BMI) and higher proportion of albumin-bilirubin (ALBI) grade 3 as significant risk factors for bleeding complications. Conclusion Atezolizumab/bevacizumab therapy for advanced HCC carries a heightened risk of gastrointestinal bleeding, exceeding that of tyrosine kinase inhibitors. High BMI and higher ALBI grade are key predictors of bleeding complications, emphasizing the need for cautious patient selection and monitoring.

中文翻译：

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接受 Atezolizumab/Bevacizumab 治疗的肝细胞癌患者的出血风险：系统评价和荟萃分析。


简介 atezolizumab/bevacizumab 联合治疗已成为晚期肝细胞癌 （HCC） 的有效一线治疗药物。然而，这种疗法可能与出血并发症有关，因此需要对其发生率和严重程度进行全面分析。本荟萃分析旨在综合临床试验和观察性研究的可用证据，以量化 atezolizumab/bevacizumab 给药后出血的患病率。方法 本荟萃分析侧重于使用 atezolizumab/bevacizumab 的 HCC 治疗，特别是检查出血并发症。它确定了给药后出血的发生率，并将风险比与酪氨酸激酶抑制剂 （索拉非尼或乐伐替尼） 进行了比较。还评估了出血并发症的危险因素。结果 涉及 3,895 名患者的 28 项研究中，出血副作用的汇总患病率为 8.42% （95% CI： 5.72-11.54）。4.42% （95% CI： 2.64-6.10） 的患者发生 III 级或 IV 级出血，2.06% （95% CI： 0.56-4.22） 观察到 V 级出血。消化道出血，主要是静脉曲张，最常见，患病率为 5.48% （95% CI： 3.98-7.17）。亚组分析表明，基于研究设计和地理位置的出血率存在差异。与酪氨酸激酶抑制剂相比，Atezolizumab/bevacizumab 治疗的出血发生率高 2.11 倍 （95% CI： 1.21-3.66）。Meta 回归分析发现，高体重指数 （BMI） 和白蛋白胆红素 （ALBI） 3 级比例较高是出血并发症的重要危险因素。 结论 阿替利珠单抗/贝伐珠单抗治疗晚期 HCC 的胃肠道出血风险更高，超过酪氨酸激酶抑制剂。高 BMI 和较高的 ALBI 分级是出血并发症的关键预测指标，强调需要谨慎选择和监测患者。