Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma

Levolger, Stef; Vledder, Mark G. van; Muslem, Rahatullah; Koek, Marcel; Niessen, Wiro J.; Man, Rob A. de; Bruin, Ron W. F. de; IJzermans, Jan N.M.

doi:10.1002/jso.23976

Cited by 85 publications

(87 citation statements)

References 31 publications

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“…A separate 2015 retrospective study reaffirmed initial findings from Harimoto et al (Levolger et al 2015). Unlike Voron et al, Levolger et al discovered that sarcopenia was associated with short-term outcomes such as increased risk of major post-operative complications and treatment-related mortality (death within 90 days of treatment).…”

Section: Impact Of Sarcopenia and So On Patient Outcomesupporting

confidence: 62%

Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

et al. 2016

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Sarcopenia, or loss of skeletal muscle mass and quality, has been studied as part of aging and adverse health outcomes in elderly patients but has only recently been evaluated as a separate condition in cancer patients and important indicator of adverse outcomes. Currently, its definition and method of assessment are still being debated. Sarcopenia within an increasingly obese population has led to a subgroup with sarcopenic obesity, at even higher risk of adverse outcomes. Yet, sarcopenia often goes undiagnosed in these patients, hidden beneath higher body mass index. Identifying sarcopenic and sarcopenic obese subpopulations would allow for more effective treatment plans and potential avoidance of suboptimal outcomes, as well as the chance to intervene and combat these modifiable risk factors. This review will examine available literature on the definition and methods of evaluating sarcopenia and sarcopenic obesity, summarize the effectiveness of sarcopenia and sarcopenic obesity as predictors of outcomes after gastrointestinal cancer surgery, including colorectal cancer resection, liver resection, and pancreatic resection, and outline strategies to minimize the impact of sarcopenia. It is clear that untreated sarcopenia and sarcopenic obesity can be associated with suboptimal post-operative outcomes, especially infections and disease-free or overall survival.

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Section: Impact Of Sarcopenia and So On Patient Outcomesupporting

confidence: 62%

Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

et al. 2016

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“…However, the latter group forms the greatest number of patients with PHC, since only around a quarter of all patients undergo resection [4-6]. The value of skeletal muscle mass and density measurements to identify patients at risk for impaired outcome seems promising, particularly in hepaticopancreatobiliary cancer patients [13, 17, 18, 39]. Unfortunately, the number of patients who underwent surgical resection was too small to validate previously described findings regarding CT-assessed skeletal muscle mass and impaired outcome in patients with PHC undergoing surgery [17, 18].…”

Section: Discussionmentioning

confidence: 99%

Low Skeletal Muscle Density Is Associated with Early Death in Patients with Perihilar Cholangiocarcinoma Regardless of Subsequent Treatment

et al. 2018

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Background: Low skeletal muscle mass is associated with increased postoperative morbidity and worse survival following resection for perihilar cholangiocarcinoma (PHC). We investigated the predictive value of skeletal muscle mass and density for overall survival (OS) of all patients with suspected PHC, regardless of treatment. Methods: Baseline characteristics and parameters regarding disease and treatment were collected from all patients with PHC from 2002 to 2014. Skeletal muscle mass and density were measured at the level of the third lumbar vertebra on CT. The association between skeletal muscle mass and density with OS was investigated using the Kaplan-Meier method and Cox survival. Results: Median OS in 233 included patients did not differ between those with and without low skeletal muscle mass (p = 0.203), whereas a significantly different median OS (months) was observed between patients with low (HR 7.0, 95% CI 4.7–9.3) and high (HR 12.1, 95% CI 8.1–16.1) skeletal muscle density (p = 0.004). Low skeletal muscle density was independently associated with decreased OS (HR 1.78, 95% CI 1.03–3.07, p = 0.040) within the first 6 months but not after 6 months (HR 0.68, 95% CI 0.44–1.07, p = 0.093), after adjusting for age, tumour size and suspected peritoneal or other distant metastases on imaging. Conclusion: A time-dependent effect of skeletal muscle density on OS was found in patients with PHC, regardless of subsequent treatment. Low skeletal muscle density may identify patients at risk for early death.

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“…Sarcopenia may also impair diaphragmatic work due to reduced muscle mass and this event may facilitate pulmonary complications especially in the context of surgery . In patients with HCC, sarcopenia is an independent prognostic factor of decreasing survival, and increasing treatment‐related complications and mortality . In addition, sarcopenic obesity and myosteatosis are independently associated with a higher long‐term mortality in cirrhosis …”

Section: Consequences Of Malnutrition Sarcopenia and Frailty In Cirrhmentioning

confidence: 99%

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

Bunchorntavakul

Reddy

2019

Aliment Pharmacol Ther

143

131

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Summary Background Malnutrition/sarcopenia and frailty are common in patients with cirrhosis and are associated with poor outcomes. Aim To provide an overview of data on the importance, assessment and management of malnutrition/sarcopenia and frailty in cirrhosis. Methods A literature search was conducted in PubMed and other sources, using the search terms “sarcopenia,” “muscle,” “malnutrition,” “cirrhosis,” “liver” and “frailty” from inception to April 2019, to identify the relevant studies and international guidelines. Results The prevalence of malnutrition/sarcopenia in cirrhosis is 23%‐60%. Frailty generally overlaps with malnutrition/sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition/sarcopenia in cirrhosis is complex/multifactorial and not just reduction in protein/calorie intake. Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched‐chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality‐ and liver‐related events, they, and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long‐term ammonia‐lowering agents and myostatin antagonists, are currently under investigation. Conclusions Malnutrition/sarcopenia and frailty are unique, inter‐related and multi‐dimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

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Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma

Abstract: Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma, mainly due to an increase in treatment-related mortality.

Cited by 85 publications

References 31 publications

Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery?

Low Skeletal Muscle Density Is Associated with Early Death in Patients with Perihilar Cholangiocarcinoma Regardless of Subsequent Treatment

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

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