Impact of Sarcopenia on Two-Year Mortality in Patients with HCV-Associated Hepatocellular Carcinoma After Radiofrequency Ablation

Abstract

Purpose Radiofrequency ablation (RFA) appears effective for the treatment of hepatocellular carcinoma (HCC). Evaluation of prognostic factors is imperative for patient selection and improving treatment efficacy. This study aimed to assess sarcopenia as a predictor of the outcome of RFA in patients with HCC. Methods This prospective study included all patients with HCC on top of HCV-related cirrhosis who underwent RFA and followed up for a minimum of two years. CT scan was used to determine the skeletal muscle index at the psoas, erector spinae, quadratus lumborum, transversus abdominis, external and internal obliques, and rectus abdominis muscles. Cross-sectional areas were calculated to obtain a lumbar skeletal muscle index (L3-SMI). Results A total of 97 patients were enrolled in the study. The L3-SMI was 46.2±12.1 cm 2 /m 2 . Older age was the only risk factor associated with sarcopenia (p = 0.001). The overall survival at two years for the whole group was 65.2%. Sarcopenia and MELD score were independent predictors of OS at two years with HR of 7.6 (95% CI: 3.1–18.7) and 2.2 (95% CI: 1.0–4.8), respectively. Recurrence-free survival was 84.1% at two years. Recurrence was not affected by all factors, including sarcopenia. Conclusion Sarcopenia is a surrogate predictor of overall survival at two years in HCC patients after RFA. Sarcopenia assessment might be an additional prognostic indicator with conventional biomarkers to optimize the selection criteria for receiving RFA for early-stage HCC.

Association between sarcopenia and prognosis of hepatocellular carcinoma: A systematic review and meta-analysis

“…Regarding the research design, 38 studies were designed as retrospective studies, and four studies were conducted prospectively. Twenty-two studies were included from Japan ( 14 , 22 – 42 ), six from Korea ( 16 , 43 – 47 ), four from China ( 48 – 51 ), two from Egypt ( 52 , 53 ), two from Germany ( 15 , 54 ), two from Italy ( 55 , 56 ), one each from Netherlands, Canada, United States of America (USA), and France ( 57 – 60 ). HCC patients were treated by hepatectomy, sorafenib, lenvatinib, TACE, yttrium-90 radioembolization, RFA, or the combination of these.…”

“…SMI is the most widely used index and sarcopenia is defined as SMI < 42 cm 2 /m 2 for men and <38 cm 2 /m 2 for women based on the guideline proposed by Japan Society of Hepatology (JSH) ( 61 ). Among twenty-seven studies using SMI, eight studies used the cut-points proposed by JSH ( 14 , 22 , 32 , 35 , 42 , 45 , 49 , 52 ), six studies employed the Martin cut-points ( 41 , 53 , 55 , 57 , 58 , 60 ), four studies applied the Vledder cut-points ( 27 , 28 , 34 , 38 ), and their own cut-points were measured in other studies. HR was estimated by univariate and multivariate Cox proportional hazards regression to investigate the influence of sarcopenia on OS and/or PFS of HCC patients in the included studies.…”

Sarcopenia does not limit overall survival after interstitial brachytherapy for breast cancer liver metastases

“…There are yet no studies investigating the influence of sarcopenia for breast cancer patients undergoing locoregional therapies. For RFA, several studies showed that low pre-treatment PMI and SMI were associated with lower OS in HCC patients after RFA [55][56][57]. Similarly, a negative influence of sarcopenia as measured by PMI and SMI on OS was found in patients undergoing trans-arterial chemo-embolization (TACE) and trans-arterial embolization (TAE) [58,59].…”

Nutritional status in patients with hepatocellular carcinoma: Potential relevance for clinical outcome

“…Impaired nutritional status also frequently occurs in cirrhotic HCC patients. Despite some negative studies [8,9], most available data suggest that impaired nutritional status is also associated with unfavorable outcome in patients with HCC in general [10][11][12][13][14][15][16][17][18] as well as after tumor-specific treatment, such as liver resection [19][20][21][22], radiofrequency ablation [23,24], sorafenib [25,26], Lenvatinib [27], embolization [28] or radiotherapy [29]. Many new therapeutic modalities have recently been introduced for HCC, but prognosis remains poor.…”