Prognostic Impact of Osteopenia in Patients Who Underwent Living Donor Liver Transplantation for Hepatocellular Carcinoma

Abstract

Background Osteopenia, loss of bone mineral density (BMD), was recently identified to be independently associated with early marker of deconditioning that precedes sarcopenia in patients with hepatocellular carcinoma (HCC). The aim of this study was to clarify the impact of osteopenia as the risk factor for mortality after living donor liver transplantation (LDLT) compared with already‐reported biological markers. Methods Data were collected retrospectively for all consecutive patients who underwent LDLT for HCC at our institution between January 1998 and December 2015. BMD was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. Data related to clinicopathological parameters and prognosis were analyzed. Results The median value of BMD was 163.6 Hounsfield units and osteopenia was identified in 103 (53.4%) of the 193 recipients, according to the age‐specific formula. In addition to the other tumor burdens, such as tumor numbers ≥5 (HR 2.521, P = 0.027), DCP levels >200 mAU/mL (HR 2.678, P = 0.006), and neutrophil‐to‐lymphocyte ratio ≥3.01 (HR 2.068, P = 0.025), osteopenia (HR 2.106, P = 0.024) was independent risk factor for mortality by multivariate analysis. Overall survival of the patients who met the two risk factors and more was significantly lower than the others (HR 5.382, P < 0.001). Besides, the calibration plot for the 5‐year overall survival using nomogram was predicted very well (C‐index 0.746). Conclusions Preoperative osteopenia was independently associated with post‐LDLT mortality among patients with HCC. Moreover, risk score and nomogram with calibration curve were developed to confirm the clinical usefulness of osteopenia for post‐LDLT patients.

Osteosarcopenia is a potential predictor for the prognosis of patients who underwent hepatic resection for colorectal liver metastases

“…Interestingly, in this study, there was no significant difference in the disease-free survival between the patients with and without osteosarcopenia. Toshima et al and Sharma et al also demonstrated that osteopenia was independently associated with post-liver transplantation survival in HCC patients, but not recurrence 15,13. They pointed out how effective treatments for recurrence were done might be related to osteopenia; however, the present study showed appropriate diagnostic cutoff values.…”

“…Inflammatory conditions, nutritional factors, and aging have been postulated as the molecular mechanism. On the other hand, there are few reports to show the prognostic value of osteopenia 13,15 . It is not clear whether the bone loss promotes cancer development or whether stable bone density prevents cancer invasion.…”

“…On the other hand, there are few reports to show the prognostic value of osteopenia. 13,15 It is not clear whether the bone loss promotes cancer development or whether stable bone density prevents cancer invasion. Gender, low body mass index, comorbidities, such as diabetes and kidney dysfunction, low levels of Vitamin D, reduced insulin-like growth factor-1, and malnutrition have been associated with osteosarcopenia.…”

Prognostic value of preoperative low bone mineral density in patients with digestive cancers: a systematic review and meta-analysis

“…After contacting the original authors, we included an additional study. Finally, 11 studies (2230 patients) were included for the meta-analysis [23][24][25][26][27][28][29][30][31][32][33].…”

“…Table 1 shows the characteristics of the included studies [23][24][25][26][27][28][29][30][31][32][33]. Of the 11 studies, three studies focused on pancreatic cancer [25,26,28], two on colorectal liver metastases [29,30], two on extrahepatic cholangiocarcinoma [24,32], one on esophageal cancer [31], one on colon cancer [33], and two on hepatocellular carcinoma [23,27]. Six studies adopted cutoff values for BMD from previous studies [23,25,33,[27][28][29], while the other five studies adopted their own cutoff values [24,26,[30][31][32].…”