Baseline Sarcopenia is Associated with Lack of Response to Therapy, Liver Decompensation and High Mortality in Hepatocellular Carcinoma Patients

Abstract

Objective: hepatocellular carcinoma (HCC) is a dreadful complication of liver cirrhosis. Aim was to study the effect of sarcopenia on the survival in patients with HCC. Methods: we included 262 patients and were followed up for 12 months. Sarcopenia was calculated by skeletal muscle index (SMI). Sarcopenia was defined by SMI ≤39 cm 2 /m 2 for women and ≤50 cm 2 /m 2 for men. Results: patients with sarcopenia (n= 113, 43.1%) were older, mainly males, Child-Pugh class B and smokers. Patients with sarcopenia had lower survival than those without (10.09 vs. 11.72 months). Survival was also lower in Barcelona clinic liver cancer stage C than B and A (9.02 vs. 11.21 vs. 11.89 months). Age and sarcopenia were hazardous of mortality (p<0.05). There was statistically significant difference of serial SMI in patients without baseline sarcopenia unlike patients with baseline sarcopenia. On follow up patients with sarcopenia had higher incidence of ascites (45% vs. 20.4%), spontaneous bacterial peritonitis (21.7% vs. 11.6%), hepatic encephalopathy (28% vs. 11.5%) and bleeding (22.9% vs. 12.7%). Totally patients with sarcopenia had higher incidence of progressive HCC (39% vs. 25.5%). Conclusion: Sarcopenia is associated with lack of response to therapy, liver decompensation and higher mortality in hepatocellular carcinoma patients.

Prognostic significance of cachexia index in patients with advanced hepatocellular carcinoma treated with systemic chemotherapy

“…Moreover, elevated IL-6 and decreased IL-15 in pre-cachetic and cachetic patients can alter the function of immune cells, which resulted reduced anti-tumor effect 35 . Notably, patients with baseline sarcopenia compared to those without, had significant higher percentage of progressive HCC despite intervention in the 1st (29.2 vs. 16.1; p = 0.023), 3rd (40.7 vs. 29.5; p = 0.001), 6th (51.4 vs. 30.6; p = 0.001) and the 12th months (32.1 vs. 25.7; p = 0.001) 36 . One previous study reported that sorafenib responses are diminished in individuals with sarcopenic obesity with increased visceral fat, which suggests body composition could be predictive marker for primary resistance to tyrosine kinase inhibitors in patients with advanced HCC 37 .…”

Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions

“…Multiple studies have reported outcomes among these patients. It has been showed that a baseline sarcopenia is associated with lack of response to HCC treatments, further decompensation episodes, and increased mortality[ 56 ]. In the following sections, we elaborate on studies evaluating the role of sarcopenia in HCC patients with various treatments such as loco-regional, surgery, transplant, and chemo/immunotherapy.…”

Untitled

“…In der aktuellen ESPEN-Leitlinie "Klinische Ernährung bei Lebererkrankungen" wird zur Bestimmung der Mangelernährung der Nutritional-Risk-Score (NRS 2002) oder Minimal Nutrition Assessment (MUST) oder The Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT) empfohlen. Sarkopenie bei Patienten mit HCC ist mit schlechter Therapieverträglichkeit sowie erhöhter Mortalität assoziiert [390][391][392][393][394]. Geringe Handkraftstärke und niedriger Phasenwinkel alpha (gemessen mit der Body-Impedance-Analyse) können Auskunft über ein erhöhtes Mortalitätsrisiko geben [395].…”