Rapidly declining skeletal muscle mass predicts poor prognosis of hepatocellular carcinoma treated with transcatheter intra-arterial therapies

Abstract

BackgroundThe impact of sarcopenia on the prognosis of patients with hepatocellular carcinoma (HCC) who receive transcatheter intra-arterial therapies, including transcatheter arterial chemoembolization and transcatheter arterial infusion chemotherapy, remains unclear. We investigated the prognostic value of skeletal muscle loss (SML) stratified by cutoffs for sarcopenia and rate of change in skeletal muscle mass over 6 months.MethodsWe retrospectively evaluated 102 patients with HCC treated with transcatheter intra-arterial therapies between 2005 and 2015. Computed tomography images of the third lumbar vertebra (L3) were analyzed to obtain the skeletal muscle area normalized for the height squared, defined as the skeletal muscle index at L3 (L3 SMI), before and 6 months after treatment. Low or high SMI was defined using cutoff values of 42 cm2/m2 in men and 38 cm2/m2 in women. The rate of change in skeletal muscle mass (ΔL3 SMI) over 6 months was calculated. Overall survival (OS) was compared in groups classified by baseline L3 SMI and ΔL3 SMI; prognostic significance was assessed with univariate and multivariate analyses, using Cox proportional hazards models.ResultsOS did not differ significantly between groups with low (n = 31) and high (n = 71) SMI at baseline (P = 0.172), but OS was significantly poorer in patients with SML (n = 41), defined as ΔL3 SMI < − 4.6% over 6 months than in those without SML (n = 61, P = 0.018). On multivariate analysis, SML (hazard ratio [HR], 1.675; 95% confidence interval [CI], 1.031–2.721; P = 0.037), serum alpha-fetoprotein ≥20 ng/mL (HR, 2.550; 95% CI, 1.440–4.515; P = 0.001), and maximum tumor diameter ≥ 30 mm (HR, 1.925; 95% CI, 1.166–3.179; P = 0.010) were independent predictors of poor OS. Baseline L3 SMI was not significantly associated with OS (HR, 1.405; 95% CI, 0.861–2.293; P = 0.174).ConclusionsΔL3 SMI was an independent prognostic factor in patients with HCC treated with transcatheter intra-arterial therapies. Further study is required to reveal whether prevention of skeletal muscle depletion might be a new therapeutic strategy to contribute to improved clinical outcomes in patients with HCC.

Skeletal muscle volume loss during transarterial chemoembolization predicts poor prognosis in patients with hepatocellular carcinoma

“…Another recent study reported that, in patients treated with sorafenib, the survival rate was worse in patients with muscle atrophy at baseline than in those with non‐muscle atrophy . In terms of hepatic intra‐arterial therapy, previous reports showed no significant association between muscle volume loss at baseline and OS . However, changes in muscle volume mass during non‐curative treatments such as sorafenib and hepatic intra‐arterial therapy have been reported to be a prognostic factor in patients with HCC .…”

“…Skeletal muscle mass is affected by both liver function reserves and tumor‐related factors in addition to age or sex in patients with HCC . Although patient background characteristics including sex, age, and liver function reserves were similar between Kobayashi et al .’s study and the present study, TNM stage was significantly more advanced in Kobayashi et al .’s study (stage III–IV; 67.6% vs. 53.1%, respectively; P = 0.024). Therefore, decreasing skeletal muscle mass early after the first TACE procedure could mainly reflect HCC status.…”

“…In one report, skeletal muscle mass decreased by 2.2% per year in patients with liver cirrhosis, and the rate of decrease increased in parallel with the severity of cirrhosis . Sarcopenia has a negative impact on mortality in patients with liver cirrhosis regardless of the presence of hepatocellular carcinoma (HCC) …”

“…Only two studies reported an association between HCC and muscle volume in patients undergoing transcatheter intra‐arterial therapies . However, these studies included patients with liver tumors other than HCC or only treated with transcatheter arterial infusion chemotherapy.…”

“…However, these studies included patients with liver tumors other than HCC or only treated with transcatheter arterial infusion chemotherapy. A recent study reported that rapidly declining skeletal muscle mass is associated with poor prognosis in patients with HCC treated with transcatheter intra‐arterial therapies . However, that study only estimated changes in skeletal muscle mass during the first 6 months from first treatment.…”