Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization

Abstract

BACKGROUND At the diagnosis of hepatocellular carcinoma (HCC), more than 90% of HCC patients present cirrhosis, a clinical condition often associated to malnutrition. Sarcopenia is an indirect marker of malnutrition assessable on computed tomography (CT). AIM To evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial (chemo)-embolization. METHODS Patients with HCC treated by a first session of trans-arterial (chemo)embolization and an available CT scan before treatment were included. Sarcopenia was assessed using skeletal muscle index at baseline and at the first radiological assessment. Radiological response was recorded after the first session of treatment using mRECIST. RESULTS Of 225 patients treated by trans-arterial bland embolization ( n = 71) or trans-arterial chemoembolization ( n = 154) for HCC between 2007 and 2013, Barcelona Clinic of Liver Cancer stage was A, B, and C in 27.5%, 55%, and 16.8% of cases, respectively. Sarcopenia was present in 57.7% of the patients. Patients with sarcopenia presented a higher rate of progressive disease (19% vs 8%, P = 0.0236), a shorter progression-free survival (8.3 vs 13.2 mo, P = 0.0035), and a shorter median overall survival (19.4 mo vs 35.5 mo, P = 0.0149) compared with non-sarcopenic patients. Finally, patients whose sarcopenia appeared after first transarterial treatment had the worst prognosis ( P = 0.0004). CONCLUSION Sarcopenia is associated with tumor progression and poor survival outcomes after trans-arterial (chemo)-embolization for HCC.

The predictive value of sarcopenia and myosteatosis in trans-arterial (chemo)-embolization treated HCC patients

“…Some studies did not find a relationship between sarcopenia and prognosis of HCC patients [8,16]. In contrast, studies with larger sample sizes and lower heterogeneous patient populations revealed that sarcopenia was an independent predictive indicator for TAE/TACE treated HCC patients [7,10,[12][13][14]17]. In our meta-analysis, pooled data from 1932 patients supported that sarcopenia was an independent poor prognostic factor for TAE or TACE treated HCC patients both in OS and in ORR.…”

“…Recent studies pointed out that sarcopenia was related to a lower overall survival and objective response rates in HCC patients who were treated by TAE/TACE, and the SMI and PMI can be adopted as predictive indicators. Nonetheless, conclusions varied since other studies reached contradictory opinions on the predictive values of sarcopenia in the prognosis of HCC [7][8][9][10][11][12][13][14][15][16]. In addition to the loss of muscle, fatty infiltration of muscle is another important clinical outcome of HCC and is usually related to a worse prognosis, however, evidence from the relative studies were limited and the ultimate conclusion still needs to be further validated [17,18].…”

Predicción de resultados a corto plazo tras hemicolectomía derecha laparoscópica. ¿Es la sarcopenia superior a otros métodos?

“…Sarcopenia is very common in gastrointestinal system malignancies, as in many cancer types 28 . The relationship between sarcopenia and oncological and clinical outcomes has been demonstrated in the previous studies [29][30][31][32] . As reported, sarcopenia is associated with a prolonged length of stay, increased mortality, and complication rates 33 .…”

Quick and easy assessment of sarcopenia in cirrhosis: Can ultrasound be the solution?

“…In patients treated with thermal ablation, sarcopenia has been linked to a reduced overall survival (OS) and to a higher risk of HCC recurrence[ 47 ]. A worse prognosis and high rate of progression has been also described for HCC patients treated with transarterial chemoembolization[ 48 ].…”