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

Abstract

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.

Clinical utility of the Liver Frailty Index for predicting muscle atrophy in chronic liver disease patients with hepatocellular carcinoma

“…Skeletal muscle mass was evaluated according to SMI using CT scans at the L3 . The CT scan used for this study was performed as part of HCC assessment.…”

“…We measured visceral fat area (VFA) using diagnostic CT scans at the umbilical level, as previously described . The CT scan images have already been performed for the assessment of HCC.…”

“…Factors correlated with SMI were evaluated by pairwise correlations . In addition, independent factors associated with muscle atrophy were analyzed using a logistic regression analysis, as previously described . Briefly, in this study, we did not conduct the univariate analysis for selection of candidates for logistic regression analysis.…”

Recent advances in the management of hepatocellular carcinoma: First, cut … is the deepest or is it “no‐touch” and exercise?

“…In Japan, the benefits of exercise for in‐hospital patients with cancer is well‐recognized and is an approved health care service by the Japanese Ministry of Health. In this issue of the Journal , a multidisciplinary team from the Kurume University School of Medicine studied the effects of exercise in patients with HCC undergoing TACE . Those enrolled in an intervention cohort, the “Exercise Group,” were instructed by physiotherapists to partake in a prescribed program consisting of stretching, strength training, balance, and endurance training .…”

“…In this issue of the Journal , a multidisciplinary team from the Kurume University School of Medicine studied the effects of exercise in patients with HCC undergoing TACE . Those enrolled in an intervention cohort, the “Exercise Group,” were instructed by physiotherapists to partake in a prescribed program consisting of stretching, strength training, balance, and endurance training . All patients received nutritional supplementation to meet energy requirements …”