Reduced Local Tumor Progression After Thermal Ablation During Atezolizumab Plus Bevacizumab Treatment for...

Background/Objectives: Although thermal ablation is an established curative treatment for early-stage hepatocellular carcinoma (HCC), local tumor progression (LTP) after ablation remains a clinically important issue. In advanced-stage HCC treated with immunotherapy, ablation is increasingly performed concurrently with atezolizumab plus bevacizumab (atezo/bev). However, evidence regarding its clinical outcome is limited. This study aimed to evaluate the association between concurrent atezo/bev and LTP after ablation. Methods: This retrospective study included 467 ablated tumors from 376 treatment courses. Tumors were classified into two groups according to atezo/bev administration status. The cumulative incidence of LTP was compared between the two groups. Factors associated with LTP and ablation-related complications were also assessed. Results: Twenty-five tumors were ablated during atezo/bev treatment in 17 treatment courses (ablation + atezo/bev group), whereas 442 tumors were ablated without concurrent atezo/bev in 359 treatment courses (ablation-alone group). The cumulative incidence of LTP was significantly lower in the ablation + atezo/bev group than in the ablation-alone group (p = 0.031). In the multivariable analysis, ongoing atezo/bev treatment was independently associated with a reduced risk of LTP (hazard ratio, 0.124; p = 0.015). No significant differences in ablation procedure-related complications were observed between the two groups. Conclusions: Thermal ablation during atezo/bev treatment was associated with a reduced risk of LTP without an apparent increase in procedure-related complications. These findings suggest that concurrent administration of atezo/bev may be associated with improved local tumor control after ablation, supporting the feasibility of ablation as part of multidisciplinary treatment strategies for advanced-stage HCC.