Sarcopenia with systemic inflammation can predict survival in patients with hepatocellular carcinoma undergoing curative resection

Abstract

Background: This study aimed to examine the prognostic significance of sarcopenia combined with systemic inflammation in patients who underwent curative hepatectomy for hepatocellular carcinoma (HCC).Methods: Between January 2010 and July 2019, we identified 159 patients with HCC who underwent curative hepatectomy at three institutional centers. We retrospectively analyzed clinicopathological outcomes, surgical outcomes, platelet lymphocyte ratio (PLR) as a systemic inflammatory marker, and computed tomography (CT)-assessed sarcopenia at the third lumbar vertebra level (L3).Results: Sarcopenia was noted in 74 (46.5%) of 159 patients and was significantly associated with male sex, low body mass index (BMI), and high PLR. In the multivariate analysis, sarcopenia [hazard ratio (HR): 2.127, P=0.026] and high PLR (HR: 1.971, P=0.038) were associated with a decrease in overall survival (OS) but not in recurrence-free survival (RFS). The combination of sarcopenia and PLR status stratified the 5-year OS into 82.0% (non-sarcopenia and a low PLR), 68.3% (sarcopenia or a high PLR), and 44.4% (sarcopenia and a high PLR) (P=0.001). In the multivariate analysis, "sarcopenia and a high PLR" and "sarcopenia or a high PLR" were revealed to be significant predictors of OS (HR: 4.300, P=0.001 and HR: 2.723, P=0.010, respectively).Conclusions: Sarcopenia and high PLR were significantly associated with poor OS. The combination of these two factors may be useful for predicting survival of patients with HCC undergoing curative hepatectomy.

Emerging Prognostic Markers in Patients Undergoing Liver Resection for Hepatocellular Carcinoma: A Narrative Review

“…Several recent studies have highlighted a close correlation between inflammatory status, nutritional status, and the prognosis of HCC patients after curative-intent hepatectomy. Specifically, prognostic nutritional index (PNI), sarcopenia status, and several blood cell ratios have been adopted as independent predictors of OS [ 76 , 77 ] ( Figure 3 ).…”

“…A meta-analysis by Man et al [ 93 ], including 13 articles and 3738 HCC cases, proved that preoperatively low levels of PNI were statistically related to postoperative early recurrence and worse OS. Furthermore, a multicenter retrospective study encompassing both nutritional and inflammatory factors established that detection of sarcopenia on computed tomography and/or a high platelet-to-lymphocyte ratio is independently associated with poor OS in HCC patients undergoing LR [ 77 ].…”

Combination of sarcopenia and systemic inflammation-based markers for predicting the prognosis of patients undergoing pancreaticoduodenectomy for pancreatic cancer

“…Systemic inflammation has been observed in patients with sarcopenia [22]. A correlation has been observed between sarcopenia accompanied by systemic inflammation and poor prognosis in patients with various types of cancer [23][24][25]. However, no study has examined the effect of sarcopenia in combination with systemic inflammation on the prognosis of patients with pancreatic cancer undergoing pancreaticoduodenectomy.…”

Platelet lymphocyte ratio and sarcopenia were associated with survival after hepatocellular carcinoma undergoing curative resection

“…We read with great interest the recently published study written by Kim and colleagues entitled “Sarcopenia with systemic inflammation can predict survival in patients with hepatocellular carcinoma undergoing curative resection” ( 1 ), which was published in the Journal of Gastrointestinal Oncology . The authors showed that sarcopenia and a high platelet lymphocyte ratio (PLR) were both significantly associated with poor OS.…”