Prognostic significance of sarcopenia in patients with hepatocellular carcinoma treated with lenvatinib

Dong, Dong; Shi, Jinyu; Shang, Xiao; Liu, Bo; Xu, Weiling; Cui, Guozhen; Wang, Nan-Ya

doi:10.1097/md.0000000000028680

Cited by 18 publications

(34 citation statements)

References 53 publications

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“…A total of 2435 studies were identified after screening the databases, from which 1867 studies were excluded, followed by reviewing the abstracts of 568 studies in accordance with the inclusion criteria. Finally, 57 studies 3 , 21 – 76 were included in this meta-analysis after detailed full-text examination (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 57 studies involving 9790 HCC patients were included in the meta-analysis. The studies were conducted in different regions, with 41 studies 3 , 24 , 26 – 28 , 32 – 37 , 39 – 41 , 43 – 51 , 54 – 60 , 62 , 63 , 66 – 69 , 71 , 73 – 76 (Japan provided the largest volume of studies, followed by the South Korea) from Asia, and 16 studies 21 – 23 , 25 , 29 – 31 , 38 , 42 , 52 , 53 , 61 , 64 , 65 , 70 , 72 conducted in non-Asia regions. The enrolled patients covered all stages of HCC (from BCLC stage 0/A to BCLC stage D) and the corresponding treatments (RFA, hepatectomy, LDLT, TACE, TARE, radiotherapy, sorafenib, lenvatinib, and ICIs).…”

Section: Resultsmentioning

confidence: 99%

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Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: an updated meta-analysis

Guo

Ren

Zhu

et al. 2023

Sci Rep

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Although numerous studies have reported the association between sarcopenia and the prognosis of hepatocellular carcinoma (HCC) patients, there is lack of a newer and more comprehensive meta-analysis. Herein, a comprehensive literature search was performed on PubMed, Web of Science, the Cochrane Library, and Embase databases to identify relevant studies published up to February 2022. The outcomes were overall survival (OS), recurrence, progression‐free survival, tumor response, severe postoperative complications, and toxicity of drugs. A total of 57 studies involving 9790 HCC patients were included in the meta-analysis. The pooled prevalence of sarcopenia in HCC patients was 41.7% (95% CI 36.2–47.2%). Results demonstrated that sarcopenia was significantly associated with impaired OS (HR: 1.93, 95% CI 1.73–2.17, P < 0.001), higher risk of tumor recurrence (HR: 1.75, 95% CI 1.56–1.96, P < 0.001), lower objective response rate (OR: 0.37 95% CI 0.17–0.81, P = 0.012), and more drug-related adverse events (OR: 2.23, 95% CI 1.17–4.28, P = 0.015) in HCC patients. The subgroup analyses revealed that the OS of patients at the early stage of tumor was more severely affected by sarcopenia than for patients at other stages. Moreover, the presence of cirrhosis and Child Pugh class B increased the hazard of mortality from sarcopenia. This study has shown that sarcopenia is highly associated with poor prognosis in HCC patients. In addition, cirrhosis and poor liver functional reserve increase the danger of sarcopenia. OS was more impaired in HCC patients with sarcopenia at early stage of tumor than at other tumor stages.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: an updated meta-analysis

Guo

Ren

Zhu

et al. 2023

Sci Rep

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the moderate risk of bias was determined to be due to study attrition in eight studies, adjustment for other prognostic factors in eight studies, statistical analysis and reporting in five studies. In general, of the 42 included studies, 34 studies were at an overall low risk of bias ( 14 – 16 , 22 – 25 , 28 – 32 , 34 , 35 , 37 , 39 – 44 , 46 , 47 , 49 – 59 ), while eight were at an overall moderate risk of bias ( 26 , 27 , 33 , 36 , 38 , 45 , 48 , 60 ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 2,295 patients from 11 studies were included in the analyzing the impact of sarcopenia on the PFS ( 26 – 28 , 33 , 34 , 37 , 38 , 44 , 45 , 48 , 49 , 60 ). An independent association between sarcopenia and reduced PFS was observed (HR = 1.33, 95% CI: 1.12–1.56), and a substantial statistical heterogeneity was exhibited ( Q = 37.24, I 2 = 70%, P < 0.01) ( Figure 4 ).…”

Section: Resultsmentioning

confidence: 99%

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

Jiang

Wang

et al. 2022

Front. Nutr.

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BackgroundSarcopenia, characterized by the loss of muscle mass, strength, and physical ability, occurs with aging and certain chronic illnesses such as chronic liver diseases and cancer. Sarcopenia is common in liver cirrhosis and hepatocellular carcinoma (HCC). Previous reports of association between sarcopenia and prognosis of HCC have been inconsistent. Therefore, the present systematic review and meta-analysis aimed to investigate the impact of sarcopenia on the survival of patients with HCC.MethodsA systematic literature search was conducted using PubMed, EMBASE, and Web of Science electronic databases from inception to May 1, 2022. We included retrospective or prospective studies investigating the association between sarcopenia and overall survival (OS) and/or progression free survival (PFS) of HCC. We applied the Quality in Prognosis Studies (QUIPS) instrument to evaluate the risk of bias and quality of included studies. The primary and secondary outcomes were the associations of sarcopenia with OS and PFS, respectively, expressed by a pooled hazard ratio (HR) and corresponding 95% confidence interval (CI). Subgroup analysis and sensitivity analysis were performed. We further evaluated the publication bias by the funnel plot and Begg’s test.ResultsA total of 42 studies comprising 8,445 patients were included. The majority of included studies were at an overall low risk of bias. The pooled prevalence of sarcopenia was 39% (95% CI: 33–45%) (n = 8,203). Sarcopenia was associated with an increased risk of shorter OS, with a pooled adjusted HR of 1.84 (95% CI: 1.62–2.09). An independent association between sarcopenia and reduced PFS was observed (HR = 1.33, 95% CI: 1.12–1.56).ConclusionThe prevalence of sarcopenia was approximately 39% among patients with HCC. Sarcopenia was independently associated with reduced OS and PFS in HCC irrespective of treatment modalities. It is imperative that interventions aimed at alleviating sarcopenia and restoring muscle mass be implemented in order to improve the survival of patients with HCC.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337797], identifier [CRD42022337797].

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The impact of lenvatinib on sarcopenia in patients with advanced unresectable hepatocellular carcinoma

Praktiknjo,

Pena Solano,

Sadeghlar

et al. 2024

Sci Rep

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Lenvatinib is a multiple receptor tyrosine kinase inhibitor (TKI) approved for first-line treatment of patients with unresectable hepatocellular carcinoma (HCC). TKI are suspected of exacerbating muscle loss in patients with cancer. In this study, we analyze the role of muscle loss in patients with advanced HCC treated with lenvatinib. This is a retrospective analysis of a real-life cohort of 25 patients with advanced HCC who were treated with lenvatinib from 2018 to March 2021 in Germany. Patients were stratified for loss of skeletal muscle area during the first three months of lenvatinib therapy. Overall survival (OS), progression-free survival (PFS) and toxicity were analyzed for all patients, especially regarding loss of muscle before and during the first three months of therapy with lenvatinib. Three months after beginning of therapy with lenvatinib, a significant reduction of muscle mass was observed in 60% of patients (p = 0.035). Despite increase of loss of skeletal muscle, patients benefitted from lenvatinib in our cohort of patients in terms of OS and PFS and did not experience increased toxicity. Furthermore, muscle loss was not a negative predictor of survival in the univariate analysis (p = 0.675). Patients with advanced hepatocellular carcinoma experience muscle loss with lenvatinib therapy. However, despite progressive muscle loss, patients benefit from a therapy with lenvatinib in terms of OS and PFS without increased toxicity. However, assessment and prophylaxis of skeletal muscle status should be recommended during a therapy with lenvatinib.

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Prognostic significance of sarcopenia in patients with hepatocellular carcinoma treated with lenvatinib

Cited by 18 publications

References 53 publications

Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: an updated meta-analysis

Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: an updated meta-analysis

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

The impact of lenvatinib on sarcopenia in patients with advanced unresectable hepatocellular carcinoma

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