Sarcopenia and intramuscular fat deposition are associated with poor survival in Indonesian patients with hepatocellular carcinoma: a retrospective study

Abstract

Background: A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Here, we evaluated the effects of SMI and IMF on the survival of Indonesian HCC patients, whose characteristics differ from those of Japanese patients. Methods: SMI and mean muscle attenuation (MA) were evaluated using computed tomography images of the third lumbar vertebra (L3) in a prospective cohort of 100 Indonesian HCC patients. Clinical, laboratory and body composition data were analysed using the Kaplan–Meier method and Cox regression model to investigate which factors are associated with prognosis. Results: Of 100 patients, 31 were diagnosed with sarcopenia (L3 SMI value ≤36.2 cm 2 /m 2 for men and ≤29.6 cm 2 /m 2 for women), and 65 had IMF deposition (MA value ≤44.4 HU for men and ≤39.3 HU for women). These groups had shorter median survival than the reference groups (both P <0.0001). In multivariable analysis, sarcopenia (hazard ratio [HR], 1.921; P = 0.016), IMF deposition (HR, 3.580; P <0.001), Barcelona Clinic Liver Cancer (BCLC) stages C and D (HR: 2.396, P <0.01 and HR: 6.131, P <0.01, respectively), Japan Integrated Staging (JIS) score 4 (HR: 2.067, P = 0.020), and male gender (HR: 3.211, P <0.001) were independently associated with mortality. Conclusion: Sarcopenia and IMF deposition showed superior value in combination with BCLC stage and JIS score for predicting the survival of Indonesian HCC patients. Increased awareness and strategies to prevent or reverse these factors might improve patient outcomes.

Computed tomography‐defined low skeletal muscle index and density in cancer patients: observations from a systematic review

“…to stratify patients into those with low and high SMD. In the remaining 17 studies assessing SMD, threshold values used ranged from ≤22.0 HU 23 to ≤44.4 HU 24–26 in male patients and ≤23.5 23 to ≤39.3 24 in female patients. Similar to their analysis of SMI, Aleixo et al reported the proportion of patients with low SMD across multiple thresholds 23 .…”

The Asian Pacific Association for the Study of the Liver clinical practice guidelines for the diagnosis and management of metabolic associated fatty liver disease

“…The reason(s) for this discrepancy remain(s) unclear but sarcopenia could be a possible explanation. Sarcopenia is a prognostic factor for Asian patients with HCC [297,[299][300][301][302][303][304][305], while physical activity is reported to be associated with better survival in patients with HCC [306]. Thus, an important aspect of management is by considering body composition that includes body fat and skeletal muscle mass, when treating patients with HCC.…”

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“…In der aktuellen ESPEN-Leitlinie "Klinische Ernährung bei Lebererkrankungen" wird zur Bestimmung der Mangelernährung der Nutritional-Risk-Score (NRS 2002) oder Minimal Nutrition Assessment (MUST) oder The Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT) empfohlen. Sarkopenie bei Patienten mit HCC ist mit schlechter Therapieverträglichkeit sowie erhöhter Mortalität assoziiert [390][391][392][393][394]. Geringe Handkraftstärke und niedriger Phasenwinkel alpha (gemessen mit der Body-Impedance-Analyse) können Auskunft über ein erhöhtes Mortalitätsrisiko geben [395].…”