Prognostic value of sarcopenia in patients with colorectal liver metastases undergoing hepatic resection

Abstract

The prognostic significance of sarcopenia has been widely studied in different cancer patients. This study aimed to analyze the influence of sarcopenia on long-term survival in patients with colorectal liver metastasis (CRLM) undergoing hepatic resection. A retrospective analysis of 182 patients undergoing hepatic resection for CRLM was performed. Sarcopenia was determinedusing the Hounsfield unit average calculation (HUAC), a measure of muscle quality-muscledensity at preoperative abdominal computed tomography scans. Sarcopenia was defined as an HUAC score of less than 22 HU calculated using receiver operating characteristic analysis. The prognostic relevance of clinical variables and overall survival (OS) and recurrence-free survival (RFS) was evaluated. Patients with sarcopenia were older (p < 0.001) and had higher prevalence of diabetics (p = 0.004), higher body mass index (BMI) (p < 0.001) and neutrophil-to-lymphocyte ratio (p = 0.026) compared to those without. Sarcopenia was not significantly associated with OS and RFS. Multivariate Cox's regression analysis showed that multinodularity (>3) (hazard ratio (HR) 2.736; 95% confidence interval (CI), 1.631-4.589; p < 0.001), high CEA level (≥20 ng/ml) (HR 1.793; 95% CI, 1.092-2.945; p = 0.021) and blood loss (≥300 cc) (HR1.793; 95% CI, 1.084-2.964; p = 0.023) were independent factors associated with OS. In subgroup analyses, sarcopenia was a significant factor of poor OS in the patients with multinodularity by univariate (p = 0.002) and multivariate analyses(HR 3.571; 95% CI, 1.508-8.403; p = 0.004). Multinodularity (>3) (HR 1.750; 95% CI, 1.066-2.872; p = 0.027), high aspartate aminotransferase level (HR 1.024; 95% CI, 1.003-1.046; p = 0.025) and male gender (HR 1.688; 95% CI, 1.036-2.748; p = 0.035) were independent factors of RFS. In conclusion, despite no significance in whole cohort, sarcopenia was predictive of worse OS in patients with multiple CRLM after partial hepatectomy.Colorectal canceris one of the leading malignanciesand the fifth most frequent cause of cancer-related deathworldwide 1,2 . Approximately 20-25% of patients have synchronous liver metastaseswhile being diagnosed, and a further 35 to 45% of patients will develop metachronoushepatic metastases following the removal ofprimary tumor 3 . The mean survival for patients with untreated colorectal liver metastasis (CRLM) has been found to range from 6-13 months 4,5 . Thus, the management of CRLM remains clinically challenging.Hepatic resection is the mainstay of treatmentand potentially curative therapy for CRLM,with reported 5-year survival of 30-50% 4-6 . However, the recurrence rate has been reported to be high(60-80%)and only 16% of these patients remain disease free for 10 years after hepatectomy 7 . Some studies have therefore tried to find probable

Psoas Muscle Index Defined by Computer Tomography Predicts the Presence of Postoperative Complications in Colorectal Cancer Surgery

“…Studying these easily accesible variables as PMI, IMAC or visceral-to-subcutaneous adipose tissue area ratio (VSR), we can conclude that application of these indexes could be a keypoint in the perioperative management, but seems to be not effective in all malignant diseases. Based on several studies with patients undergoing liver resection for colorectal metastases the sarcopenia expressed by preoperative quality and quantity of skeletal muscle and visceral adiposity were not predictors of poor prognosis [ 43 , 44 ] and also sarcopenia is not a significant risk factor of overall and recurrence free survival [ 45 ].…”

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

“…The sample size of the included studies ranged from 47 to 539 patients. [15][16][17][18][19][20][21][22][23][24][25] Median follow-up ranged between 21 and 74 months. Four studies did not report on follow-up duration.…”

“…16,17,22,23 Median or mean follow-up did not exceed 36 months in five studies. 15,[18][19][20]25 None of the studies reported significant differences in tumour characteristics between the sarcopenic and nonsarcopenic patients. The baseline characteristics of the sarcopenic and non-sarcopenic groups in the various studies are displayed in the supplementary materials, table 4.…”

“…To measure skeletal muscle density, three studies used the intra-muscular adipose tissue content (IMAC), measured at the level of the umbilicus 16,17,23 and one study used the Hounsfield unit average calculation (HUAC) measured at the height of the fourth lumbar vertebra (L4) endplate. 18 Six studies used pre-defined cut-off levels based on previous literature 15,17,[19][20][21]24 , while in five studies receiver operating curves, optimal stratification or sensitivity analysis were used to define the optimal cut-off. 16,18,22,23,25 The references used for the cutoff values are Prado 28 .…”

“…18 Six studies used pre-defined cut-off levels based on previous literature 15,17,[19][20][21]24 , while in five studies receiver operating curves, optimal stratification or sensitivity analysis were used to define the optimal cut-off. 16,18,22,23,25 The references used for the cutoff values are Prado 28 . The prevalence of sarcopenia ranged from 16% to 65% per study.…”