Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments

Abstract

Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients’ survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed.

Imaging Software-Based Sarcopenia Assessment in Gastroenterology: Evolution and Clinical Meaning

“…Moreover, this method to assess sarcopenia was evaluated in patients with liver disease and HCC [ 12 , 21 , 45 , 46 ]. As abovementioned, cross imaging analysis allows easy quantification of sarcopenia in cirrhotic patients.…”

“…Even if malnutrition and sarcopenia are different conditions, they often overlap and the latter is now considered a diagnostic criterion of the former [ 17 ]. Recent evidence showed that sarcopenia in cirrhotic patients is an independent predictor of lower survival and is associated with an increased hospital stay [ 18 ], a higher rate of complications [ 19 , 20 ], poorer outcomes in patients with hepatocellular carcinoma (HCC) [ 21 ], and worse quality of life [ 22 ]. It has also been associated with increased waiting list mortality [ 13 ] and is a predictor of a higher rate of infections in patients following liver transplantation [ 23 ].…”

How to Treat Hepatocellular Carcinoma in Elderly Patients

“…Overall, these data highlight the role of muscle metabolism in HCC patients and especially in older ones, showing that improving the muscular status of these patients could be advantageous in their clinical management, particularly in advanced stages where supportive therapy plays a fundamental role [ 160 ].…”

Clinical Benefits of Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma

“…In contrast, the JSH proposed a diagnostic criterion for sarcopenia in patients with chronic liver disease of "loss of muscle mass plus low muscle strength" [47]. However, in previous reports, skeletal muscle depletion has been commonly used as the definition for sarcopenia in patients with HCC [48,49]. Previous studies analyzing HCC patients who received sorafenib demonstrated that skeletal muscle depletion was almost associated with poor prognosis [48][49][50][51][52][53].…”

“…However, in previous reports, skeletal muscle depletion has been commonly used as the definition for sarcopenia in patients with HCC [48,49]. Previous studies analyzing HCC patients who received sorafenib demonstrated that skeletal muscle depletion was almost associated with poor prognosis [48][49][50][51][52][53]. Similarly, it has been reported that skeletal muscle depletion was a poor prognostic factor in patients with HCC treated with lenvatinib [54].…”