Preoperative computed tomography-assessed skeletal muscle index is a novel prognostic factor in patients with hepatocellular carcinoma following hepatectomy: a meta-analysis

Abstract

Background: Recently, several studies have examined the association between preoperative sarcopenia and prognosis evaluation in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. However, their conclusions remain ambiguous and controversial. Thus, we conducted a meta-analysis to assess the prognostic role of preoperative sarcopenia in patients with HCC undergoing hepatectomy. Methods: We searched the existing literature reporting on the prognostic value of preoperative computed tomography (CT)-assessed sarcopenia for the survival of patients with HCC undergoing hepatectomy. The pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of overall survival (OS) and disease-free survival (DFS) were used to assess the prognostic value of preoperative sarcopenia in HCC patients. The associations between preoperative sarcopenia and clinicopathological characteristics were also evaluated. Results: A total of six studies with 1,420 patients (including 458 sarcopenia and 962 non-sarcopenia patients) were included in the meta-analysis. The results showed that preoperative sarcopenia was significantly associated with poor OS (HR =1.572, 95% CI: 1.342-1.840, P=0) and shorter DFS (HR =1.544, 95% CI: 1.178-2.024, P=0.002) in patients with HCC undergoing hepatectomy. Preoperative sarcopenia was also significantly related to larger diameter tumors (WMD =0.598, 95% CI: 0.216-0.980, P=0.002). The results of the sensitivity analysis were stable in this meta-analysis. Egger's tests revealed that there was no significant publication bias.Conclusions: Sarcopenia appears to have significant adverse impacts on postoperative outcomes in patients with hepatocellular carcinoma following hepatectomy. However, further large-scale prospective studies are needed to confirm our findings.

Sarcopenia and long-term survival outcomes after local therapy for colorectal liver metastasis: a meta-analysis

“…Previous meta-analyses for several other primary malignancies, including hepatocellular carcinoma and colorectal cancer, have found a decreased OS and RFS in sarcopenic patients. 9,[29][30][31] The effect size found in these cancers was somewhat higher (OS 1.57-1.83; RFS 1.54-1.55). 29,31 Similar to the results of this meta-analysis, reported HRs for OS were generally higher than for DFS/RFS.…”

“…9,[29][30][31] The effect size found in these cancers was somewhat higher (OS 1.57-1.83; RFS 1.54-1.55). 29,31 Similar to the results of this meta-analysis, reported HRs for OS were generally higher than for DFS/RFS. This suggests that sarcopenia mostly reflects an impaired performance status rather than unfavorable tumour biology.…”

CT-based skeletal muscle loss for predicting poor survival in patients with hepatocellular carcinoma experiencing curative hepatectomy plus adjuvant transarterial chemoembolization: a preliminary retrospective study

“…In addition, some prior studies also identified either low SMI or sarcopenia as indicative of recurrence and reduced survival for HCC patients undergoing hepatectomy [ 20 , 25 – 27 ]. However, this study indicated that preoperative SMI did not stratify liver-related mortality risk, which could be a result of different endpoint and additional adjuvant TACE treatment.…”

Update on perioperative management of patients undergoing surgery for liver cancer

“…While some of the algorithms are complicated, CRP and serum albumin measurements are used more often as components of combined indices. 39 The use of sarcopenia to predict outcomes in patients with cancer has attracted more attention, including those with HCC [46][47][48] or colorectal liver metastases (CRLM) 49,50 undergoing hepatic resection. Previous studies also demonstrated that sarcopenia increased the risk of postoperative morbidity and longer hospital stay, as well as readmission rates, after partial liver resection for CRLM.…”