Muscle Steatosis is an Independent Predictor of Postoperative Complications in Patients with Hepatocellular Carcinoma

Hamaguchi, Yuhei; Kaido, Toshimi; Okumura, Shinya; Kobayashi, Atsushi; Fujimoto, Yasuhiro; Ogawa, Kohei; Mori, Akira; Hammad, Ahmed; Hatano, Etsuro; Üemoto, Shinji

doi:10.1007/s00268-016-3504-3

Cited by 50 publications

(68 citation statements)

References 39 publications

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“…Second, it is necessary to consider whether the use of the cutoff values for body composition parameters that we had previously investigated was adequate in this study. In our previous studies [23,25,26,37], the cutoff values for body composition parameters had been determined based on receiver operating characteristic curves. Although the use of receiver operating characteristic curves provides a more accurate and objective method than the use of SDs for designing cutoff levels, these values differ markedly between study populations.…”

Section: Discussionmentioning

confidence: 99%

“…The median duration of follow-up for these patients was 42.6 months (interquartile range [IQR] 19.7-71.7). Details about the surgical procedures of hepatectomy, pathological examination, and follow-up after hepatectomy have been described previously [25,26].…”

Section: Patientsmentioning

confidence: 99%

“…In addition, muscle quality was examined by intramuscular adipose tissue content (IMAC) at the L3 level. The IMAC was calculated as follows [24][25][26]: IMAC = CT attenuation value of the multifidus muscles (HU)/CT attenuation value of the subcutaneous fat (HU) (Fig. 1d).…”

Section: Color Version Available Onlinementioning

confidence: 99%

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Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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Objective: Visceral adiposity, defined as a high visceral-to-subcutaneous adipose tissue area ratio (VSR), has been shown to be associated with poor outcomes in several cancers. However, in the surgical field, the significance of visceral adiposity remains controversial. The present study investigated the impact of visceral adiposity as well as sarcopenic factors (low muscularity) on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Patients and Methods: This retrospective study analyzed data from 606 patients undergoing hepatectomy for HCC at our institution between April 2005 and March 2016. Using preoperative plain computed tomography imaging at the level of the third lumbar vertebra, visceral adiposity, skeletal muscle mass, and muscle quality were evaluated by the VSR, skeletal muscle mass index (SMI), and intramuscular adipose tissue content (IMAC), respectively. The impact of these parameters on outcomes after hepatectomy for HCC was analyzed. Results: The overall survival rate was significantly lower among patients with a high VSR (p < 0.001) than among patients with a normal VSR. Similarly, the recurrence-free survival rate was significantly lower among patients with a high VSR (p = 0.016). A high VSR, low SMI, and high IMAC contributed to an increased risk of death (p < 0.001) and HCC recurrence (p < 0.001) in an additive manner. Multivariate analysis showed that not only preoperative low muscularity but also visceral adiposity was a significant risk factor for mortality (hazard ratio [HR] = 1.566, p < 0.001) and HCC recurrence (HR = 1.329, p = 0.020) after hepatectomy for HCC. Conclusions: Preoperative visceral adiposity, as well as low muscularity, was closely related to poor outcomes after hepatectomy for HCC. It is crucial to establish a new strategy including perioperative nutritional interventions with rehabilitation for better outcomes after hepatectomy for HCC.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

et al. 2018

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“…Fifteen studies [11,13,[20][21][22][23] [32], and 1 in China [26]. Among the included studies, 13 studies were directed at liver [11,13,[19][20][21][22][23][24][25][26][27][28][29] malignancy, 2 bile duct [30,31], 6 pancreas [12,14,[32][33][34][35], 2 periampullary [36,37], 4 periampullary and pancreas [38][39][40][41], and 1 hepatopancreatobiliary [42]. The sample size ranged from 67 to 763.…”

Section: Study Characteristicsmentioning

confidence: 99%

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

et al. 2018

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Background: Computed tomography (CT)-assessed sarcopenia indexes have been reported to predict postoperative morbidity and mortality; however conclusions drawn from different indexes and studies remain controversial. Aim: The purpose of this meta-analysis was to evaluate various CT-assessed sarcopenia indexes as predictors of risk for major complications in patients undergoing hepatopancreatobiliary surgery for malignancy. Methods: Medline/PubMed, Web of Science, and Embase databases were systematically searched to identify relevant studies published before June 2018. PRISMA guidelines for systematic reviews were followed. The pooled risk ratio (RR) for major postoperative complications (Clavien-Dindo ≥III) was estimated in patients with sarcopenia versus patients without sarcopenia. Data extracted were meta-analyzed using Review Manager (version 5.3). Results: Twenty-eight studies comprising 6,656 patients were included in this study. CT-assessed sarcopenia indexes, such as skeletal muscle index (SMI, RR 1.36; 95% CI 1.14–1.63; p = 0.0008; I² = 24%), psoas muscle index (PMI, RR 1.35; 95% CI 1.15–1.58; p = 0.0002; I² = 0%), muscle attenuation (MA, RR 1.40; 95% CI 1.14–1.73; p = 0.002; I² = 4%), and intramuscular adipose tissue content (IMAC, RR 1.63; 95% CI 1.28–2.09; p < 0.0001; I² = 0%) were all predictors of postoperative major complications, although moderate heterogeneity existed and cutoffs for these indexes to define sarcopenia varied. Conclusions: All commonly used CT-assessed sarcopenia indexes, such as SMI, PMI, MA, and IMAC can predict the risk of major postoperative complications; however, a consensus on the cutoffs for these indexes to define sarcopenia is still lacking.

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“…It has become widely recognized in the hepatology field because of the significant influence of MML on patients with liver disease. MML is a poor prognostic factor in cirrhosis or hepatocellular carcinoma (HCC) patients [8,9], and a predictor of the development of complications [10,11] and outcomes after surgical treatment [12].…”

Section: Introductionmentioning

confidence: 99%

Constraining Effect of Mild Portal Hypertension against the Negative Influence of Muscle Mass Loss in Cirrhosis after Esophageal Variceal Eradication

Kobayashi¹,

Maruyama²,

Kiyono³

et al. 2017

Clinical-Investigation

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Background: To elucidate the role of muscle mass loss (MML) in the long-term outcome of cirrhosis after the endoscopic eradication of esophageal varices (EV). Methods and findings:This is a subgroup analysis of 82 prospectively enrolled cirrhosis patients with eradicated EV. A severe portal hypertension (PH) was defined by post-treatment hepatic venous pressure gradient ≥12 mmHg. MML was assessed by skeletal muscle index at the L3 lesion (cm 2 /m 2 ) with the cut-off values of 38 for women and 42 for men (median observation period, 37.4 months). Twenty-four patients (29.3%) had MML. Multivariate analysis showed that a presence of hepatocellular carcinoma (P<0.0001) and a presence of MML (P=0.002) were significant prognostic factors. In the cohort with severe PH, the survival rate was significantly lower in patients with MML than in those without. However, in the cohort without severe PH, the survival rate showed no difference between patients with MML (100% at 1year, 50% at 3 years and 5 years) and those without (92.3% at 1 year and 3 years, 71.8% at 5 years; P=0.278). Conclusions:MML is an independent prognostic factor after the eradication of EV in cirrhosis, and the mild PH exerts a constraining effect against the negative influence of MML.

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Muscle Steatosis is an Independent Predictor of Postoperative Complications in Patients with Hepatocellular Carcinoma

Cited by 50 publications

References 39 publications

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

Computed Tomography-Assessed Sarcopenia Indexes Predict Major Complications following Surgery for Hepatopancreatobiliary Malignancy: A Meta-Analysis

Constraining Effect of Mild Portal Hypertension against the Negative Influence of Muscle Mass Loss in Cirrhosis after Esophageal Variceal Eradication

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