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.