Stratifying Cardiovascular Risk in Patients With HCC Receiving Atezolizumab/Bevacizumab: A Comparison of ESC and CARDIOSOR Scores.
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Stefanini Bernardo, Rimassa Lorenza, Iavarone Massimo, Cabibbo Giuseppe, Marra Fabio, Vivaldi Caterina, Dalbeni Andrea, Ponziani Francesca Romana, Palloni Andrea, Lonardi Sara, Lani Lorenzo, Federico Piera, Svegliati-Baroni Gianluca, Pressiani Tiziana, Ielasi Luca, Mazzarelli Chiara, De Lorenzo Stefania, Sacco Rodolfo, Bruccoleri Mariangela, Celsa Ciro, Mastro Alessio, Masi Gianluca, Auriemma Alessandra, Stella Leonardo, Toniutto Pierluigi, Villani Rosanna, Deiana Chiara, Ascari Sara, Marseglia Mariarosaria, Granito Alessandro, Piscaglia Fabio, Tovoli Francesco, ARTE Study Group
Аннотация
METHODS: We retrospectively analysed prospectively collected data from the multicenter Italian ARTE database, including patients with uHCC treated with first-line AB between June 2022 and July 2025. Traditional major adverse cardiovascular events (tMACE) were defined as acute coronary syndromes, heart failure, cerebrovascular events, or peripheral ischemia, while an extended composite (eMACE) additionally included venous thromboembolism and immune-related myocarditis. Cardiovascular risk was stratified using the European Society of Cardiology (ESC) Cardio-Oncology classification and the CARDIOSOR score. Competing-risk analyses were performed considering treatment discontinuation as a competing event.
RESULTS: This study included 538 patients (median age 69.8 years). During follow-up, 20 patients (3.7%) experienced tMACE, and 30 (5.6%) experienced eMACE. Patients assigned to the very high-risk category by ESC criteria and those with a high-risk CARDIOSOR score had a significantly increased risk of tMACE and eMACE. Both scores demonstrated a moderate ability to stratify cardiovascular risk (Harrell's c-index 0.68 for ESC and 0.59 for CARDIOSOR).
CONCLUSIONS: Cardiovascular adverse events were uncommon overall, but their incidence was not negligible in patients in high-risk subgroups. Risk scores may help identify vulnerable subgroups and support patient-tailored treatment strategies, including consideration of bevacizumab-free regimens in selected cases.
TRIAL REGISTRATION: Multicenter ARTE database (NCT06806579).