Impact of Grip Strength in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib

Abstract

Although sarcopenia is characterized by a loss of muscle strength and skeletal muscle mass, few studies have evaluated the effect of muscle strength on hepatocellular carcinoma (HCC) patients. We evaluated the impact of sarcopenia-related factors (grip strength (GS) and the skeletal muscle index (SMI)) on the survival among lenvatinib-treated unresectable HCC (u-HCC) patients. This single-center cohort study was conducted at a university hospital. The study population included 63 lenvatinib-treated u-HCC patients managed between April 2018 and April 2020. A decreased GS and decreased SMI were found in 21 (33.3%) and 22 (34.9%) patients, respectively. The overall survival (OS) of the normal GS group was significantly higher than that of the decreased GS group, while that of the normal and decreased SMI groups did not differ markedly. There were no significant differences in the progression-free survival between the normal GS and decreased GS groups or the normal SMI and decreased SMI groups. A multivariate Cox proportional hazards model showed that modified albumin-bilirubin-grade (mALBI) 2b (hazard ratio (HR) 4.39) and a decreased GS (HR 3.55) were independently associated with an increased risk of poor prognosis. In addition to the hepatic functional reserve, a decreased GS was a poor prognostic factor in lenvatinib-treated u-HCC patients.

Prognostic value of low skeletal muscle mass in hepatocellular carcinoma patients treated with sorafenib or lenvatinib: A meta-analysis

“…18 records didn't meet the inclusion criteria and were discarded: 2 involving other kinase inhibitors (Nault et al, 2013[ 28 ], 2015[ 29 ]), 9 with overlapped patient data (Antonelli et al, 2018[ 2 ]; Gigante et al, 2015[ 13 ]; Hoshino et al, 2015[ 16 ]; Imai et al, 2015[ 17 ], 2019[ 19 ]; Labeur et al, 2018[ 23 ][ 24 ]; Okada et al, 2019[ 33 ]; Saeki et al, 2019[ 34 ]), 5 lacking HR and 95 % CI (Mir et al, 2012[ 26 ]; Okada et al, 2020[ 32 ]; Saeki et al, 2018[ 35 ]; Uchikawa et al, 2020[ 39 ]; Ueki et al, 2016[ 40 ]), 1 without any interesting outcome (Cheng et al, 2019[ 7 ]) and 1 with low quality and faulty data (Nishikawa et al, 2017[ 30 ]). Thus, 11 retrospective studies (Antonelli et al, 2018[ 3 ]; Endo et al, 2020[ 10 ]; Hiraoka et al, 2017[ 15 ]; Imai et al, 2020[ 18 ]; Labeur et al, 2019[ 25 ]; Naganuma et al, 2017[ 27 ]; Sawada et al, 2019[ 36 ]; Takada et al, 2018[ 38 ]; Uojima et al, 2020[ 41 ]; Wu et al, 2021[ 43 ]; Yamashima et al, 2017[ 45 ]) were included in this meta-analysis, comprising 1148 patients. The flow diagram of this study selection process is shown in Figure 1 (Fig.…”

“…The demographic and characteristics of the 11 eligible studies are shown in Table 1 (Tab. 1) (References in Table 1: Antonelli et al, 2018[ 3 ]; Endo et al, 2020[ 10 ]; Hiraoka et al, 2017[ 15 ]; Imai et al, 2020[ 18 ]; Labeur et al, 2019[ 25 ]; Naganuma et al, 2017[ 27 ]; Sawada et al, 2019[ 36 ]; Takada et al, 2018[ 38 ]; Uojima et al, 2020[ 41 ]; Wu et al, 2020[ 43 ]; Yamashima et al, 2017[ 45 ]). Out of these retrospective studies, 9 were performed in Asia (8 in Japan and 1 in China) and the remaining 2 in Europe (Netherlands and Italy).…”

“…The main results of the crude and adjusted pooled analysis are reported in Figure 2A and 2B (Fig. 2) (References in Figure 2: Antonelli et al, 2018[ 3 ]; Endo et al, 2020[ 10 ]; Hiraoka et al, 2017[ 15 ]; Imai et al, 2020[ 18 ]; Labeur et al, 2019[ 25 ]; Naganuma et al, 2017[ 27 ]; Sawada et al, 2019[ 36 ]; Takada et al, 2018[ 38 ]; Uojima et al, 2020[ 41 ]; Wu et al, 2020[ 43 ]; Yamashima et al, 2017[ 45 ]) respectively. Ten studies involving 1028 patients provided the crude HRs and 95 % CIs of the association between the LSMM and HCC patients treated with sorafenib or lenvatinib (Antonelli et al, 2018[ 3 ]; Endo et al, 2020[ 10 ]; Hiraoka et al, 2017[ 15 ]; Imai et al, 2020[ 18 ]; Labeur et al, 2019[ 25 ]; Naganuma et al, 2017[ 27 ]; Sawada et al, 2019[ 36 ]; Takada et al, 2018[ 38 ]; Uojima et al, 2020[ 41 ]; Yamashima et al, 2017[ 45 ]).…”

Calf and arm circumference as simple markers for screening sarcopenia in patients with chronic liver disease

“…However, those studies had individually defined cut‐off values for a low SMI and were not guideline‐based. More recent studies have reported that low grip strength (muscle strength) has a greater effect on the prognosis than a low skeletal muscle mass in patients with CLD as well as patients with HCC treated with lenvatinib 45–47 . In fact, the European Working Group on Sarcopenia in Older People (EWGSOP) guidelines state that a low muscle strength is the primary parameter of sarcopenia, as muscle strength is the most reliable measure of the muscle function 21 .…”

Lenvatinib for Hepatocellular Carcinoma: A Literature Review

“…Another retrospective study showed that the OS of patients with a normal grip strength (GS) was better than that in those with decreased GS, and a normal GS was found to be significantly associated with OS in a multivariate analysis [104]. While the ORR and PFS did not differ to a statistically significant extent between the two groups, the post-progression survival in patients with a normal GS was longer in comparison to that in patients with decreased GS, which indicated that patients with a normal GS may be more likely to have a maintained liver function and PS, raising the possibility of anticancer therapy after progression [104]. Although studies concerning sarcopenia have been limited, Sarcopenia might impact the therapeutic efficacy of lenvatinib treatment.…”