Relationship between presarcopenia and event occurrence in patients with primary hepatocellular carcinoma

Abstract

Presarcopenia is a prognostic factor in patients with hepatocellular carcinoma (HCC). The Japan integrated staging (JIS) score is a prognostic method that combines the Child–Turcotte–Pugh classification and the tumor-node-metastasis (TNM) staging for HCC. We investigated the relationship between presarcopenia, the JIS score, and prognosis in patients with primary HCC. This retrospective study included 153 patients with primary HCC who were hospitalized from October 2011 to March 2018 at Municipal Hospital of Kofu. The skeletal muscle mass was measured using simplified psoas muscle mass index (PMI) based on CT imaging, and PMI using the volume analyzer SYNAPSE VINCENT ver3.0. We diagnosed presarcopenia based on the cut off value according to the assessment criteria for sarcopenia in liver disease defined by the Japan Society of Hepatology. Forty-three patients (28%) were diagnosed with presarcopenia. The median event-free survival was significantly worse in patients with presarcopenia than those without presarcopenia (P = 0.016). In multivariate analysis, presence of presarcopenia, JIS score ≥3, alpha-fetoprotein ≥200 ng/ml, and prothrombin induced by vitamin K absence-II ≥ 200 mAU/ml were significant prognostic factors. Among the patients with JIS scores ≥3, there was no difference in the event occurrence rate with presence of presarcopenia (P = 0.96). Among the patients with JIS scores ≤2, the median event-free-survival was significantly shorter in those with presarcopenia than those without presarcopenia (P = 0.045). Presarcopenia was an independent prognostic factor in patients with primary HCC. In patients with JIS scores ≤2, the median event-free survival was significantly shorter in those with presarcopenia compared to those without presarcopenia. In the patients with JIS scores ≥3, there was no difference in the event occurrence rates in those with and without presarcopenia.

Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions

“…Early sarcopenia can be seen in HCC individuals[ 24 , 55 ]. Myokines (myostatin, IL-6, follistatin) are cytokines produced and secreted by muscle fibers and can exert paracrine/autocrine effects[ 33 ].…”

Assessment of lower limb muscle strength can predict fall risk in patients with chronic liver disease

“…Secondary sarcopenia in patients with cancer or chronic diseases is also a poor prognostic factor. The incidence of sarcopenia in patients with chronic liver disease (CLD) has been increasing 12 , 16 , 17 . According to the guidelines on sarcopenia in liver disease by the Japan Society of Hepatology, sarcopenia is defined by decreased grip strength (GS) and skeletal muscle mass; it is a hot topic in the field of liver diseases 18 .…”

“…According to the guidelines on sarcopenia in liver disease by the Japan Society of Hepatology, sarcopenia is defined by decreased grip strength (GS) and skeletal muscle mass; it is a hot topic in the field of liver diseases 18 . Due to sarcopenia, the frequency of hospitalization in patients with primary hepatocellular carcinoma (HCC) increases as a result of fall fractures, infection, encephalopathy, ascites, and death 12 . Therefore, it is important to predict the risk of falls in patients with CLD, even if they are not elderly, as they have reduced muscle strength and muscle mass, i.e.…”

Radiological Assessment of Sarcopenia and Its Clinical Impact in Patients with Hepatobiliary, Pancreatic, and Gastrointestinal Diseases: A Comprehensive Review

“…There were 34 studies (7,836 patients, age 53.9 to 73 years) reporting radiological assessment of sarcopenia and its prognostic impact in CLD patients with HCC. 10 15 16 18 21 24 25 28 31 36 39 43 45 53 56 61 64 68 74 80 86 89 92 101 105 109 111 119 121 123 129 131 133 137 There were 32 retrospective and 2 prospective studies. The studies included both newly diagnosed and advanced HCCs.…”