Adverse impact of low skeletal muscle index on the prognosis of hepatocellular carcinoma after hepatic resection

Yabusaki, Norimitsu; Fujii, Tsutomu; Yamada, Suguru; Suzuki, Kôjiro; Sugimoto, Hiroyuki; Kanda, Mitsuro; Nakayama, Goro; Koike, Masahiko; Fujiwara, Michitaka; Kodera, Yasuhiro

doi:10.1016/j.ijsu.2016.04.049

Cited by 66 publications

(77 citation statements)

References 38 publications

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“…We enrolled 209 consecutive HCC patients with CLD from February 2013 to November 2016. Hospitalized HCC patients with CLD who met the following criteria were included: those 20 years of age or older, those with a performance status of grade 0 to 2, as defined by the Eastern Cooperative Oncology Group, and those treated with TACE . Patients were excluded if there was a risk of HCC rupture, they had hepatic encephalopathy grade 2–4 according to the West Haven Criteria, , there was a risk of esophageal varices rupture, they had heart failure, or they had respiratory failure …”

Section: Methodsmentioning

confidence: 99%

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Effects of in‐hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization

Koya

Kawaguchi

Hashida

et al. 2018

J of Gastro and Hepatol

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Background and Aim Sarcopenia is a prognostic factor in hepatocellular carcinoma (HCC) patients. HCC patients who underwent transcatheter arterial chemoembolization (TACE) are at a risk of muscle atrophy. We aimed to investigate the effects of in‐hospital exercise on muscle mass and factors associated with muscle hypertrophy in HCC patients who underwent TACE. Methods We enrolled 209 HCC patients who underwent TACE. Patients were classified into either an exercise (n = 102) or control (n = 107) group. In the exercise group, patients were treated with in‐hospital exercise (median 2.5 metabolic equivalents/20–40 min/day). The effects of exercise on muscle mass were evaluated by changes in skeletal muscle index (ΔSMI) between before and after TACE. Factors associated with an increase in SMI were analyzed by logistic regression and decision‐tree analyses. Results There was no significant difference in serum albumin and bilirubin levels between the two groups. ΔSMI was significantly higher in the exercise group than in the control group (0.28 cm2/m2 vs −1.11 cm2/m2, P = 0.0029). In the logistic regression analysis, exercise was an independent factor for an increase in SMI (hazard ratio 2.13; 95% confidence interval 1.215–3.846; P = 0.0085). Moreover, the decision‐tree analysis showed that exercise was the initial divergence variable for an increase in SMI (the ratio of increased SMI: 53% in the exercise group vs 36% in the control group). Conclusions In‐hospital exercises increased muscle mass in HCC patients who underwent TACE. In addition, exercise was an independent factor for muscle hypertrophy. Thus, in‐hospital exercise may prevent sarcopenia in HCC patients who underwent TACE.

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Section: Methodsmentioning

confidence: 99%

“…Sarcopenia is defined as the generalized loss of muscle mass and muscle strength . Sarcopenia is frequently seen in patients with chronic liver disease (CLD), and it has an adverse impact on clinical outcomes, including poor quality of life, development of hepatocellular carcinoma (HCC), and poor survival rates …”

Section: Introductionmentioning

confidence: 99%

Effects of in‐hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization

Koya

Kawaguchi

Hashida

et al. 2018

J of Gastro and Hepatol

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“…In terms of patient demographic characteristics, female patients accounted for 28.4% of the investigated population and the mean (or median) age of the enrolled patients in each study (or its subgroup) ranged between 57 and 73.9 years. Regarding the pattern of underlying malignancy, 7 studies included patients with resectable HCC [21][22][23][24][25][26][27], 3 included patients with any clinical stage of HCC [20,28,29], 1 included patients with primary liver tumors (69.8% had HCC) [30], 1 included patients with hepatic cancers (50.5% had HCC) undergoing intraarterial therapy [31], and 1 included patients with HCC following sorafenib treatment [32]. The muscle volume was estimated on the transverse CT image at the third lumbar vertebra level in all the selected studies, although the intensity window -(shown by using the Hounsfield scale) for recognizing skeletal muscles and cut-off points for sarcopenia -varied across trials ( Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The crude pooled HR of skeletal muscle mass loss for recurrence-free survival from 6 studies was calculated to be 1.85 (95% CI: 1.44-2.37) [21,22,24,[26][27][28], while the adjusted summary HR from 4 selected trials was 1.76 (95% CI: 1.27-2.45) (Fig. 5) [22,23,26,27]. The test for heterogeneity was not significant for both pooled values (I 2 < 0.001 and p value = 0.577 for the crude HRs; I 2 = 43.85 and p value = 0.148 for the adjusted HRs).…”

Section: Recurrence-free Survivalmentioning

confidence: 99%

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Chang¹,

Chen

Wu³

et al. 2017

Liver Cancer

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140

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Background: Hepatocellular carcinoma (HCC) has multiple prognostic factors, and there is an increase in knowledge about the body composition and physical status of patients with HCC. The present meta-analysis aimed to explore whether loss of skeletal muscle mass is associated with mortality and tumor recurrence in patients with HCC. Method: A systematic search was conducted for published literature using PubMed, Embase, and Scopus. We included cohort or case-control studies investigating patients with HCC. The primary and secondary outcomes were the associations of loss of skeletal muscle mass with overall survival and tumor recurrence, respectively, expressed by a summary hazard ratio (HR) and 95% confidence interval (CI). Result: A total of 13 studies comprising 3,111 patients were included. The summary HRs calculated by either univariate or multivariate analysis both suggested a significant association between sarcopenia and all-cause mortality (crude HR = 2.04, 95% CI: 1.74-2.38; adjusted HR = 1.95, 95% CI: 1.60-2.37). Similarly, loss of skeletal muscle mass was associated with tumor recurrence (crude HR = 1.85, 95% CI: 1.44-2.37; adjusted HR = 1.76, 95% CI: 1.27-2.45). The stratified analysis showed that treatment types and inclusion of body mass index or body weight in the Cox regression model did not modify both clinical outcomes. With an increase in cut-off values of muscle mass on computed tomography images (especially for male patients), there was an insignificant trend of stronger associations between loss of skeletal muscle mass and all-cause mortality. Conclusion: Loss of skeletal muscle mass is associated with increased all-cause mortality and tumor recurrence in patients with HCC. Further prospective studies incorporating measurements of muscle strength and physical function are warranted to see whether inclusion of both parameters better predicts the outcome than use of muscle mass only.

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“…Predefined cutoffs were adopted in 8 studies [11,20,[24][25][26][27][28]39], and optimum stratification, receiver operator characteristic curve and study-specific percentiles were used in the other studies [12-14, 21-23, 29-38, 40-42]. Sex-specific cutoffs were employed in almost all of the included studies, and on comparison with males, females showed a relatively lower muscle mass and MA (Table 3).…”

Section: Cutoff For the Sarcopenia Indexmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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Adverse impact of low skeletal muscle index on the prognosis of hepatocellular carcinoma after hepatic resection

Abstract: Low-SMI was an independent adverse prognostic factor for CRR in patients with BMI ≥22. Therefore, preventing muscle wasting may improve the CRR of patients with HCC.

Cited by 66 publications

References 38 publications

Effects of in‐hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization

Effects of in‐hospital exercise on sarcopenia in hepatoma patients who underwent transcatheter arterial chemoembolization

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

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