Association of myosteatosis with treatment response and survival in patients with hepatocellular carcinoma undergoing chemoembolization: a retrospective cohort study

Abstract

Patients with hepatocellular carcinoma (HCC) have poor prognosis and have frequent treatment-related toxicities resulting in cancer-associated cachexia. This study aimed to determine the association of myosteatosis and sarcopenia on mortality in patients with HCC treated with transarterial chemoembolization (TACE). Six hundred and eleven patients diagnosed with HCC and underwent TACE at a tertiary care center between 2008 and 2019 were included. Body composition was assessed using axial CT slices at level L3 to calculate the skeletal muscle density for myosteatosis and skeletal muscle index for sarcopenia. The primary outcome was overall survival while the secondary outcome was TACE response. Patients with myosteatosis had a poorer TACE response than patients without myosteatosis (56.12% vs. 68.72%, adjusted odds ratio [OR] 0.49, 95% confidence interval [CI] 0.34–0.72). The rate of TACE response in patients with sarcopenia was not different from those without sarcopenia (60.91% vs. 65.22%, adjusted OR 0.79, 95% CI 0.55–1.13). Patients with myosteatosis had shorter overall survival than without myosteatosis (15.9 vs. 27.1 months, P < 0.001). In the multivariable Cox regression analysis, patients with myosteatosis or sarcopenia had higher risk of all-cause mortality than their counterparts (adjusted hazard ratio [HR] for myosteatosis versus no myosteatosis 1.66, 95% CI 1.37–2.01, adjusted HR for sarcopenia versus no sarcopenia 1.26, 95% CI 1.04–1.52). Patients with both myosteatosis and sarcopenia had the highest 7 year mortality rate at 94.45%, while patients with neither condition had the lowest mortality rate at 83.31%. The presence of myosteatosis was significantly associated with poor TACE response and reduced survival. Identifying patients with myosteatosis prior to TACE could allow for early interventions to preserve muscle quality and might improve prognosis in HCC patients.

Prevalence of and Impact on the Outcome of Myosteatosis in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

“…In total, 27 articles were initially identified from the literature search, but only 12 studies fulfilled the inclusion criteria and underwent further evaluation ( Supplementary Figure S1 ) [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Three studies from a single center in Japan [ 17 , 21 , 22 ] had overlapping study periods, and therefore only the most recent study [ 17 ] was included.…”

“…Three studies from a single center in Japan [ 17 , 21 , 22 ] had overlapping study periods, and therefore only the most recent study [ 17 ] was included. Thus, 10 studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], that evaluated the prevalence of myosteatosis in HCC patients, fulfilled all inclusion criteria and were included in the final analysis. Four studies were derived from Japan [ 11 , 15 , 17 , 19 ] and one each from Thailand [ 12 ], Germany [ 13 ], China [ 14 ], Italy [ 16 ], Taiwan [ 18 ] and Indonesia [ 20 ].…”

“…Thus, 10 studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], that evaluated the prevalence of myosteatosis in HCC patients, fulfilled all inclusion criteria and were included in the final analysis. Four studies were derived from Japan [ 11 , 15 , 17 , 19 ] and one each from Thailand [ 12 ], Germany [ 13 ], China [ 14 ], Italy [ 16 ], Taiwan [ 18 ] and Indonesia [ 20 ]. MRI was used for the evaluation of myosteatosis in only one study [ 11 ].…”

“…MRI was used for the evaluation of myosteatosis in only one study [ 11 ]. Eight of the ten studies had a retrospective design [ 11 , 12 , 13 , 14 , 16 , 17 , 18 , 19 ]. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the included studies [ 23 ].…”

“…In most patients (93.6% or 3105/3316), the diagnosis of myosteatosis was defined using the gender-based definition with different cutoffs between males and females (e.g., <39.3 HU in females and <44.4 HU in males), while in two studies that included 211 patients, myosteatosis was defined as having a muscle/m 2 radiodensity at the third lumbar vertebra of <41 HU for patients with a dry BMI < 25 kg/m 2 and <33 HU for those with a ΒΜΙ ≥ 25 kg/m 2 (i.e., BMI-based definition) [ 13 , 18 ]. According to the available data, chronic viral hepatitis (B or C) was the underlying cause of liver disease in 72.5% (2404/3316) of patients, while 28.9% of the patients (854/2953) had T2DM [ 11 , 12 , 15 , 16 , 17 , 19 ]. In addition, 92.4% (3065/3316) of patients were from Asia, and among the 3216 patients with available data, 2633 (81.9%), 561 (17.5%) and 22 (0.6%) of them were classified as CP class A, B and C, respectively [ 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”