Prognostic value of sarcopenic visceral obesity in hepatocellular carcinoma treated with TACE

Abstract

Although Transartial chemoembolization (TACE) is one of the recommended treatments for hepatocellular carcinoma (HCC), there is always a dispute on the selection of the best beneficiary for treatment. We studied the prognostic value of nutritional markers, obesity, visceral obesity and sarcopenia on survival outcomes under single and different combinations. In a retrospective cohort of 235 patients with HCC at different stages, more accurate comprehensive prognostic factors were obtained by combining and comparing the multifactor hazard ratios (HR) of various parameters, including skeletal muscle index (SMI) and visceral fat index (VFI) obtained by computer tomography, laboratory index albumin-to-globulin (A/G) ratio, anthropometric body mass index (BMI) and other parameters. The study cohort was dominated by men (73.6%), with a median age of 54 years. According to the survival outcome of HCC patients, we obtained the ideal sex cutoff value of VFI: ≥40.54 cm2/m2 for males (the receiver operating characteristic curve [ROC] = 0.764, P < .001) and ≥ 43.19 cm2/m2 for females (ROC = 0.718, P < .05). According to the results of multifactor analysis, sarcopenic visceral obesity (HR = 8.35, 95% confidence intervals [CI] = [4.96, 14.05], P < .001) is more effective than any single or combined prognosis assessment, including sarcopenic dystrophy (HR = 2.70, 95% CI = [1.85, 3.95], P < .001), sarcopenic obesity (HR = 5.23, 95% CI = [3.41, 8.02], P < .001), sarcopenia (HR = 5.74, 95% CI = [3.61, 9.11], P < .001) and visceral obesity (HR = 3.44, 95% CI = [2.24, 5.27], P < .001). Sarcopenic visceral obesity, defined by SMI and VFI, is a more objective and accurate prognostic indicator of HCC.

Impact of Low Muscle Mass on Hepatocellular Carcinoma Patients Undergoing Transcatheter Liver-Directed Therapies: Systematic Review & Meta-Analysis

“…Of the 12 studies included [13][14][15][16][17][18][19][20][21][22][23][24], eight were from Asian countries [13,15,17,19,[21][22][23][24], and four were from non-Asian countries [14,16,18,20]. In terms of treatment options, nine studies utilized TACE [13,15,17,[19][20][21][22][23][24], two employed TAE [14,18], and one applied TARE [16]. Previous studies have employed different muscle mass measurements.…”

“…One study reported both SMI and PMI; considering the study's main result, we included the PMI data into the meta-analysis [22]. Seven records used the SMI [17][18][19][20][21]23,24], two used the PMI [13,15], and two used the FFMA [14,16]. The median observation period was five years (range: 3.3-16.7 years).…”

“…All the patients had an observation period of >34 months, which was the anticipated median survival time for patients with intermediate HCC following TACE therapy [30]. Regarding the risk of bias, three studies were rated as high [15,17,24] and nine as moderate [13,14,16,[18][19][20][21][22][23] (Supplementary Table S4).…”

“…Previous studies have reported associations between LSMM and survival outcomes in patients with intermediate-stage HCC undergoing various transcatheter liver-directed intra-arterial therapies, such as TACE, TAE, and TARE [13][14][15][16][17][18][19][20][21][22][23][24]. However, the results of these studies have been inconsistent.…”

“…However, the results of these studies have been inconsistent. Although two studies found no association between baseline LSMM and overall survival (OS) in patients with HCC undergoing TACE [15,17], others have suggested that LSMM is associated with a marked reduction in OS [13,[20][21][22][23][24]. The complexity and variability of these findings make it challenging to draw definitive conclusions based on any single study.…”