Real-world Predictors of Early Mortality and Treatment Discontinuation in HCC Patients Treated with Atezolizumab–Bevacizumab

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide. Atezolizumab combined with bevacizumab is the current first-line standard for advanced HCC, but its performance in real-world settings warrants further exploration. Methods: We conducted a retrospective, multicenter study involving 80 patients treated between January 2022 and January 2024 across four Italian oncology centers. The primary objectives were early mortality and treatment discontinuation. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and safety profile. Results: Early mortality occurred in 41.2% of patients. MELD score > 11 was the only independent predictor of early death (OR: 17.52, p < 0.001), while ECOG ≥ 2 did not retain significance in multivariate analysis. Treatment discontinuation was infrequent (5%), and the combination therapy was generally well tolerated. Conclusions: MELD > 11 strongly predicted early mortality in this real-world cohort, highlighting the importance of accurate liver function assessment before treatment initiation. These findings suggest that MELD may be a valuable tool in guiding therapeutic decisions for advanced HCC in routine clinical practice.