Skeletal Muscle Volume and Intramuscular Adipose Tissue Are Prognostic Predictors of Postoperative Complications After Hepatic Resection

Harimoto, Norifumi; Hoshino, Hiromitsu; Muranushi, Ryo; Hagiwara, Kaoru; Yamanaka, Takahiro; Ishii, Norihiro; Tsukagoshi, Mariko; Igarashi, Takamichi; Watanabe, Akira; Kubo, Norio; Araki, Kenichirou; Shirabe, Ken

doi:10.21873/anticanres.12810

Cited by 14 publications

(15 citation statements)

References 27 publications

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“…The development of ascites in patients with HCC is associated with various factors, including malnutrition (8) The controlling nutritional status (CONUT) score is a nutritional index consisting of three parameters: Serum albumin level, total cholesterol level, and lymphocyte count (9) CONUT is superior than other nutritional assessment tools such as the Nutrition Risk Screening-2002 and subjective global assessment to predict infectious complication in patients with digestive diseases (10). In addition, the CONUT score was reported to predict the development of ascites in patients with HCC (11) While, intramuscular adipose tissue (IMAT) content is a method for the quantification of fatty infiltration in skeletal muscles (12) IMAT is reported to be an independent risk factor for mortality in patients with HCC (13) IMAT was also reported to be significantly associated with liver dysfunction and the prognosis of HCC patients who underwent hepatectomy (14).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and profiles of ramucirumab‑associated severe ascites in patients with hepatocellular carcinoma

et al. 2021

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Severe ascites is an adverse event of ramucirumab (RAM), a second-line treatment for hepatocellular carcinoma (HCC). Ascites can be associated with various factors, including nutritional status and muscle quality. The aim of the present study was to investigate the prevalence and profiles of RAM-associated severe ascites in patients with HCC. This retrospective study enrolled 14 consecutive patients with HCC treated with RAM (median age, 72 years; Barcelona Clinic Liver Cancer stage B/C, 6/8). Nutritional status and muscle quality were evaluated using the controlling nutritional status (CONUT) score and intramuscular adipose tissue (IMAT) content, respectively. Factors associated with severe ascites were evaluated using decision-tree analysis. The median progression-free survival (PFS) time was 2.1 months, and the overall objective response and disease control rates were 14 and 50%, respectively. Severe ascites developed in 57.1% of the patients, and the median onset was 37.5 days (range, 14-61 days) after initiation of RAM treatment. In the decision-tree analysis, the CONUT score and IMAT content were the first and second splitting variables for the development of severe ascites. In patients with a CONUT score ≥5 and IMAT <-0.54, the prevalence of severe ascites was 80 and 100%, respectively. A high incidence of severe ascites was observed in patients treated with RAM. A CONUT score ≥5 and an IMAT <-0.54 were associated with severe ascites. Thus, caution must be taken for severe ascites in patients with HCC treated with RAM, in particular patients with malnutrition and fat infiltration in muscle.

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Section: Introductionmentioning

confidence: 99%

Prevalence and profiles of ramucirumab‑associated severe ascites in patients with hepatocellular carcinoma

et al. 2021

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“…Recent studies have shown that sarcopenia and visceral adiposity, as a more and more closely watched predictor, play important roles in nutritional assessment, which has been proven to be related to postoperative complications in various diseases including gastric cancer, hepatocellular carcinoma (HCC), pancreatic cancer, and endometrial cancer (38)(39)(40)(41)(42). However, the impacts of preoperative sarcopenia, muscle steatosis, and visceral adiposity on short-term outcomes after liver resection for HAE remain unclear.…”

Section: Discussionmentioning

confidence: 99%

A new sarcopenia score prognostic for postoperative complications in hepatic alveolar echinococcosis: a multicenter retrospective study

Wang

Chen

et al. 2020

Ann Transl Med

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Background: Skeletal muscle depletion and excessive visceral adipose tissue have been shown to be independent risk factors for postoperative complications (PCs) in various diseases. However, their impact on surgical PCs in hepatic alveolar echinococcosis (HAE) is still unknown. Methods:We retrospectively reviewed the clinical data of HAE patients who underwent liver resection at our hospital between January 2008 and December 2018. We segmented skeletal muscle and adipose tissue and measured the area of skeletal muscle tissue and adipose tissue at the level of the third lumbar vertebra by manual tracing from preoperative plain computed tomography (CT) images. Sarcopenia features were selected to construct a formula based on the least absolute shrinkage and selection operator (LASSO) logistic regression model in the primary set. Then, integrating the results of multiple clinicopathologic characteristics, we built a nomogram for predicting major PCs in HAE. The results were validated using bootstrap resampling and clinical data from other HAE centers in western China. Results:The sarcopenia score is based on the personalized levels of the five features from the primary set (n=233). In the multivariate logistic analysis of the primary set, the independent factors for PCs were γ-glutamyl transferase (GGT), and surface area of hepatectomy, which were integrated into the nomogram combined with sarcopenia score. The model had a good prediction capability with a C-index of 0.84 (95% CI, 0.72-0.96). The calibration plot for the probability of PCs showed an optimal agreement between the nomogram predictions and actual observations in the primary and validation sets. Conclusion:Our study showed that sarcopenia score was significantly correlated with PCs in patients with HAE. In addition, we constructed a prognostic nomogram for predicting complications in HAE patients after liver surgery. The nomogram displayed excellent discrimination and calibration. Improving the nutritional status and physical health of patients before surgery might reduce the incidence of postoperative complications for the high-risk patients.

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“…Skeletal muscle quality, visceral fat mass, and skeletal muscle mass were measured on preoperative CT images using the graphic analysis software Ziostation (ZIOSOFT). For muscle quality, CT values (Hounsfield units: HUs) of the regions of interest were measured at the umbilical level, and the intramuscular adipose tissue content (IMAC) was calculated by dividing the CT value of the multifidus muscles by that of subcutaneous fat, as in previous studies 18‐22 . Visceral fat area (VFA), defined as HUs of −150 to −50, was measured at the umbilical level and skeletal muscle, defined as HUs of −29 to 150, at the level of the third lumbar vertebra.…”

Section: Methodsmentioning

confidence: 99%

“…The European Working Group on Sarcopenia in Older People revised its guidelines in 2018 and included reduced skeletal muscle quality in addition to reduced quantity to confirm the diagnosis of sarcopenia 15 . Recently, studies have been published linking poor skeletal muscle quality to postoperative complications in patients with gynecologic cancer, 16 colorectal cancer, 17 and hepatocellular carcinoma 18,19 . The relationship between muscle quality and postoperative complications in patients with gastric cancer is inadequately studied.…”

Section: Introductionmentioning

confidence: 99%

Impact of preoperative muscle quality on postoperative severe complications after radical gastrectomy for gastric cancer patients

Matsui

Inaki

Tsuji

2021

Annals of Gastroent Surgery

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Skeletal Muscle Volume and Intramuscular Adipose Tissue Are Prognostic Predictors of Postoperative Complications After Hepatic Resection

Abstract: Intensive surgical care is necessary for high-risk patients with hemodialysis, psychiatric disorder, high CONUT count and/or low skeletal muscle quality to reduce postoperative complication.

Cited by 14 publications

References 27 publications

Prevalence and profiles of ramucirumab‑associated severe ascites in patients with hepatocellular carcinoma

Prevalence and profiles of ramucirumab‑associated severe ascites in patients with hepatocellular carcinoma

A new sarcopenia score prognostic for postoperative complications in hepatic alveolar echinococcosis: a multicenter retrospective study

Impact of preoperative muscle quality on postoperative severe complications after radical gastrectomy for gastric cancer patients

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