Effect of Handgrip Strength on Clinical Outcomes of Patients with Hepatocellular Carcinoma Treated with Lenvatinib

Abstract

Previous studies have reported prognostic factors for hepatocellular carcinoma (HCC) patients receiving lenvatinib; however, no studies have evaluated the effects of both handgrip strength and skeletal muscle mass on the clinical outcomes. Therefore, this retrospective study investigated the individual effect of handgrip strength, skeletal muscle mass, and sarcopenia on clinical outcomes of 53 HCC patients treated with lenvatinib. Before receiving lenvatinib, handgrip strength and skeletal muscle index (SMI) were measured. Low handgrip strength and muscle depletion were defined as <26 and <18 kg and SMI <42 and SMI <38 cm2/m2 in men and women, respectively. Sarcopenia was defined as having low handgrip strength and muscle depletion. Multivariate analysis identified modified albumin–bilirubin grade 1–2a (p = 0.010), Barcelona Clinic Liver Cancer stage A–B (p = 0.011), and absence of low handgrip strength (p = 0.015) as favorable prognostic factors for survival. Furthermore, sarcopenia was an independent significant prognostic factor for survival. Time to treatment failure was associated with handgrip strength and sarcopenia. Our findings suggest that handgrip strength may be a useful marker of clinical outcomes in HCC patients treated with lenvatinib.

Management of Systemic Therapies and Hepatic Arterial Infusion Chemotherapy in Patients with Advanced Hepatocellular Carcinoma Based on Sarcopenia Assessment

“…The first report on the relationship between skeletal MM and clinical outcome was described in 2020, when Uojima et al [ 37 ] demonstrated that low MM was significantly associated with worse time to treatment failure and worse OS. Thereafter, two reports were published at the same time in which skeletal muscle depletion was not found associated with OS, unlike in a previous report [ 17 , 18 ]. In contrast, Hiraoka et al [ 38 ] recently reported that low MM was a significant prognostic factor.…”

“…We collected four articles in which both HGS and MM were evaluated in patients with HCC [14,17,18] or LC/ Liver Cancer 2022;11:329-340 DOI: 10.1159/000522389 HCC [16]. We divided the patients into four groups according to the JSH criteria [7].…”

“…Therefore, there are some future directions for research in this area: (1) the definition of sarcopenia should be established for each region and race; (2) an alternate procedure for the measurement of skeletal MM using BIA needs to be established because the current procedure is a time-consuming method and involves radiation exposure; (3) as it has been reported that HGS was lost 2-5 times faster than skeletal MM [55], HGS might be a potential early predictor for OS in patients with HCC treated with MTAs, compared to skeletal MM. Further studies are required on this topic because of the limited number of reports [17][18][19]; and (4) the assessment of skeletal muscle changes in patients with HCC treated with sequential therapy using MTAs is required to prolong survival. Moreover, there is a need to assess the contribution of nutritional therapy and/or cancer rehabilitation to maintaining skeletal MM during sequential therapy using MTAs.…”

“…Another report also showed a moderate correlation between HGS and MM ( r = 0.38) in patients with HCC ( n = 107) [ 14 ]. We measured these parameters in 53 patients with HCC [ 17 ] and found that the correlation coefficients in men and women were 0.35, and 0.20, respectively (data not shown). Therefore, the correlation between HGS and MM was weak to moderate in the previous reports, including ours.…”

“…Two research groups, including ours, have demonstrated low HGS, but not skeletal muscle depletion, as an independent unfavorable prognostic factor for survival in patients with HCC treated with lenvatinib [ 17 , 18 ] (Table 1 ). However, these were single-center studies with a small number of patients and short observation periods.…”