Sarcopenia and myosteatosis are associated with survival in patients receiving immunotherapy for advanced hepatocellular carcinoma

Chen, Bang-Bin; Liang, Po-Chin; Shih, Tiffany Ting-Fang; Liu, Tsung-Hao; Shen, Ying‐Chun; Lu, Lichun; Lin, Zhong-Zhe; Hsu, Chiun; Hsu, Chih-Hung; Cheng, Ann‐Lii; Shao, Yu‐Yun

doi:10.1007/s00330-022-08980-4

Cited by 23 publications

(28 citation statements)

References 38 publications

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“…33,34 Two recent studies reported that patients with sarcopenia or with decrease in SMI showed a worse radiological response when compared with those without, although this difference was not significant. 35,36 Similarly, the ORR in patients without sarcopenia tended to be higher than patients with sarcopenia in this study.…”

Section: Discussionsupporting

confidence: 57%

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor

Guo

Ren

et al. 2022

Therap Adv Gastroenterol

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Background: Sarcopenia is a progressive generalized loss of skeletal muscle mass commonly observed in advanced stages of cancer. Objective: To assess the relationship between sarcopenia and the prognosis of patients with hepatocellular carcinoma (HCC) treated with a programmed cell death 1 (PD-1) inhibitor. Design: This is a retrospective study. Methods: This study included patients with HCC treated with camrelizumab between 1 March 2020 and 1 December 2021. The skeletal muscle area at the L3 vertebra middle level was used to calculate the skeletal muscle index. Propensity score matching (PSM) analysis was used to balance the variables between the two groups. Results: In all, 97 patients with HCC were included in the study, with 46 and 51 patients in the sarcopenia group and the non-sarcopenia group, respectively. The baseline characteristics of albumin, Child-Pugh class, albumin–bilirubin score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were significantly different between the two groups. In total, 26 patients from each group ( n = 52) were selected after the PSM analysis. The progression-free survival (PFS) in the non-sarcopenia group was significantly longer than that in the sarcopenia group before and after PSM analysis (6.5 versus 4.8 months, p = 0.038). In addition, the disease control rate was similar before and after PSM analysis (57.7% versus 69.2%, p = 0.388). The objective response rate in the non-sarcopenia group tended to be higher than that in the sarcopenia group (11.5% versus 30.8%, p = 0.090, after PSM), but no statistically significant difference was found. The median overall survival (OS) in the non-sarcopenia group tended to longer than it in the sarcopenia group before PSM without significant differences (16.3 versus 11.3 months, p = 0.090) and the median OS was similar between the two groups after PSM (16.3 versus 16.8 months, p = 0.735). Conclusions: HCC patients with sarcopenia tended to have higher levels of inflammation and lower levels of albumin than patients without sarcopenia. Sarcopenia is associated with a shorter PFS in HCC patients treated with PD-1 inhibitor.

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Section: Discussionsupporting

confidence: 57%

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor

Guo

Ren

et al. 2022

Therap Adv Gastroenterol

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“…A prior study by Chen et al. demonstrated an association between sarcopenia and adverse outcomes in individuals with HCC undergoing treatment with ICIs ( 14 ). Nevertheless, Matsumoto et al.…”

Section: Discussionmentioning

confidence: 99%

Progressive sarcopenia and myosteatosis predict prognosis of advanced HCC patients treated with immune checkpoint inhibitors

Liu,

Jin,

Wang

et al. 2024

Front. Immunol.

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BackgroundImmunotherapy stands as a pivotal modality in the therapeutic landscape for the treatment of advanced hepatocellular carcinoma, yet responses vary among patients. This study delves into the potential impact of sarcopenia, myosteatosis and adiposity indicators, as well as their changes during immunotherapy, on treatment response and prognosis in patients with advanced hepatocellular carcinoma treated with immune checkpoint inhibitors.MethodsIn this retrospective analysis, 116 patients with advanced hepatocellular carcinoma receiving immune checkpoint inhibitors were recruited. Skeletal muscle, intramuscular, subcutaneous, and visceral adipose tissue were assessed by computed tomography at the level of the third lumbar vertebrae before and after 3 months of treatment. Sarcopenia and myosteatosis were evaluated by skeletal muscle index and mean muscle density using predefined threshold values. Patients were stratified based on specific baseline values or median values, along with alterations observed during the treatment course. Overall survival (OS) and progression-free survival (PFS) were compared using the log-rank test and a multifactorial Cox proportional risk model.ResultsA total of 116 patients were recruited and divided into two cohorts, 81 patients for the training set and 35 patients for the validating set. In the overall cohort, progressive sarcopenia (P=0.021) and progressive myosteatosis (P=0.001) were associated with objective response rates, whereas progressive myosteatosis (P<0.001) was associated with disease control rates. In the training set, baseline sarcopenia, myosteatosis, and subcutaneous and visceral adipose tissue were not significantly associated with PFS and OS. In multivariate analysis adjusting for sex, age, and other factors, progressive sarcopenia(P=0.002) and myosteatosis (P=0.018) remained independent predictors of PFS. Progressive sarcopenia (P=0.005), performance status (P=0.006) and visceral adipose tissue index (P=0.001) were all independent predictors of OS. The predictive models developed in the training set also had good feasibility in the validating set.ConclusionProgressive sarcopenia and myosteatosis are predictors of poor clinical outcomes in patients with advanced hepatocellular carcinoma receiving immune checkpoint inhibitors, and high baseline visceral adiposity is associated with a poorer survival.

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“…Despite the clear negative implication of musculature abnormalities (sarcopenia, myosteatosis, and sarcopenic obesity) on the outcome in cirrhosis and HCC setting, there is limited data on the pathophysiologic mechanism [ 1 , 15 , 16 , 17 , 18 ]. Recent studies have revealed that besides its well-known functions, skeletal muscle is an endocrine organ that can modulate different organs, including the immune system [ 19 , 20 ].…”

Section: The Impact Of Skeletal Muscle Abnormalities On Hcc Outcomementioning

confidence: 99%

“…In addition to their role in T cell exhaustion, TGF-ß and Il 6 seem to be responsible for the impaired response to immunotherapy [ 67 , 68 ]. In an Asian HCC population assigned to immunotherapy ( n = 138), sarcopenia was present in 46.5% of patients and it was associated with poor survival outcomes (HR = 2.09, p = 0.003) [ 16 ]. On the contrary, in an American HCC cohort ( n = 57) assessed to immunotherapy, sex-specific sarcopenia showed a trend of worse OS (HR: 1.71, 95%) but was not statistically significant ( p = 0.215) [ 64 ].…”

Section: The Impact Of Skeletal Muscle Abnormalities On Hcc Outcomementioning

confidence: 99%

“…Thus, patients with myosteatosis had a higher incidence of major postoperative complications ( p = 0.007) and tendentially worse survival (median survival: 41 vs. 60 months, p = 0.223) [ 52 ]. In two Asian cohorts assigned to immunotherapy (discovery cohort n = 111, validation cohort n = 27), myosteatosis was an independent predictor of progression-free survival ( p = 0.014) and OS ( p = 0.007), while sarcopenia was independent for OS ( p = 0.007) in these patients [ 16 ].…”

Section: The Impact Of Skeletal Muscle Abnormalities On Hcc Outcomementioning

confidence: 99%

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What Is the Role of Body Composition Assessment in HCC Management?

Radu

Ebadi

Montano‐Loza

et al. 2022

Cancers

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In the last decade, body composition (BC) assessment has emerged as an innovative tool that can offer valuable data concerning nutritional status in addition to the information provided by the classical parameters (i.e., body mass index, albumin). Furthermore, published data have revealed that different types of body composition are associated with different outcomes. For example, abnormalities of skeletal muscle, a common finding in cirrhotic and oncologic patients, are associated with poor outcome (i.e., high morbidity and high mortality). The disposition (visceral/subcutaneous adipose tissue) and radiodensity of adipose tissue proved to also be determinant factors for HCC outcome. Despite all the advantages, BC assessment is not part of the standard pre-therapeutic workup. The main reasons are the high heterogeneity of data, the paucity of prospective studies, the lack of a standard assessment method, and the interpopulation variation of BC. This paper aims to review the available evidence regarding the role of BC as a prognostic tool in the HCC population undergoing various therapies.

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Sarcopenia and myosteatosis are associated with survival in patients receiving immunotherapy for advanced hepatocellular carcinoma

Cited by 23 publications

References 38 publications

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor

Progressive sarcopenia and myosteatosis predict prognosis of advanced HCC patients treated with immune checkpoint inhibitors

What Is the Role of Body Composition Assessment in HCC Management?

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