Sarcopenia is a risk factor for the recurrence of hepatocellular carcinoma after curative treatment

Kamachi, Saori; Mizuta, Toshihiko; Otsuka, Taiga; Nakashita, Shunya; Ide, Yasushi; Miyoshi, Anderson; Kono, Kenji; Eguchi, Yuichiro; Ozaki, Iwata; Anzai, Keizo

doi:10.1111/hepr.12562

Cited by 89 publications

(67 citation statements)

References 40 publications

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“…In the USA, sarcopenia reportedly occurs in 40–70% of patients with cirrhosis, which is a higher prevalence than among patients with inflammatory bowel disease (approximately 20%) . In Japan, sarcopenia incidence among patients with cirrhosis has been reported to range from 10% to 70% …”

Section: Epidemiology and Clinical Significance Of Sarcopenia In Livementioning

confidence: 99%

“…Many of these studies focus on hepatectomy or liver transplantation for HCC. Among patients undergoing hepatectomy, those with sarcopenia had worse survival prognoses and significantly higher rates of postoperative recurrence . Among patients undergoing liver transplantation, sarcopenia was associated with poor post‐transplant prognoses due to an increased risk of infection, such as sepsis, and other postoperative complications .…”

Section: Epidemiology and Clinical Significance Of Sarcopenia In Livementioning

confidence: 99%

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Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria

Nishikawa

Shiraki

Hiramatsu

et al. 2016

Hepatology Research

511

713

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Sarcopenia is defined by muscle loss and muscle dysfunction. Sarcopenia is classified into primary and secondary types, based on the cause. Primary sarcopenia is mainly aging-related sarcopenia, whereas secondary sarcopenia is the reduced muscle mass and strength that accompanies an underlying disease. Given the essential role of the liver in metabolism, secondary sarcopenia due to nutritional disorders or other factors can frequently occur in liver disease. In 2015, the Japan Society of Hepatology (JSH) decided to establish its own assessment criteria for sarcopenia in liver disease because the number of liver disease patients with sarcopenia is expected to increase and there is cumulative evidence to indicate sarcopenic patients have poor clinical outcomes. A working group to create assessment criteria for sarcopenia has thus been established by the JSH. In this article, we summarize the current knowledge with regard to sarcopenia and present the assessment criteria for sarcopenia in liver disease proposed by the JSH (1st edition). To the best of our knowledge, this is globally the first proposed assessment criteria for sarcopenia specializing in liver disease.

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Section: Epidemiology and Clinical Significance Of Sarcopenia In Livementioning

confidence: 99%

Section: Epidemiology and Clinical Significance Of Sarcopenia In Livementioning

confidence: 99%

Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria

Nishikawa

Shiraki

Hiramatsu

et al. 2016

Hepatology Research

511

713

View full text Add to dashboard Cite

show abstract

“…The crude pooled HR of skeletal muscle mass loss for recurrence-free survival from 6 studies was calculated to be 1.85 (95% CI: 1.44-2.37) [21,22,24,[26][27][28], while the adjusted summary HR from 4 selected trials was 1.76 (95% CI: 1.27-2.45) (Fig. 5) [22,23,26,27]. The test for heterogeneity was not significant for both pooled values (I 2 < 0.001 and p value = 0.577 for the crude HRs; I 2 = 43.85 and p value = 0.148 for the adjusted HRs).…”

Section: Recurrence-free Survivalmentioning

confidence: 99%

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Chang¹,

Chen

Wu³

et al. 2017

Liver Cancer

159

140

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Background: Hepatocellular carcinoma (HCC) has multiple prognostic factors, and there is an increase in knowledge about the body composition and physical status of patients with HCC. The present meta-analysis aimed to explore whether loss of skeletal muscle mass is associated with mortality and tumor recurrence in patients with HCC. Method: A systematic search was conducted for published literature using PubMed, Embase, and Scopus. We included cohort or case-control studies investigating patients with HCC. The primary and secondary outcomes were the associations of loss of skeletal muscle mass with overall survival and tumor recurrence, respectively, expressed by a summary hazard ratio (HR) and 95% confidence interval (CI). Result: A total of 13 studies comprising 3,111 patients were included. The summary HRs calculated by either univariate or multivariate analysis both suggested a significant association between sarcopenia and all-cause mortality (crude HR = 2.04, 95% CI: 1.74-2.38; adjusted HR = 1.95, 95% CI: 1.60-2.37). Similarly, loss of skeletal muscle mass was associated with tumor recurrence (crude HR = 1.85, 95% CI: 1.44-2.37; adjusted HR = 1.76, 95% CI: 1.27-2.45). The stratified analysis showed that treatment types and inclusion of body mass index or body weight in the Cox regression model did not modify both clinical outcomes. With an increase in cut-off values of muscle mass on computed tomography images (especially for male patients), there was an insignificant trend of stronger associations between loss of skeletal muscle mass and all-cause mortality. Conclusion: Loss of skeletal muscle mass is associated with increased all-cause mortality and tumor recurrence in patients with HCC. Further prospective studies incorporating measurements of muscle strength and physical function are warranted to see whether inclusion of both parameters better predicts the outcome than use of muscle mass only.

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“…Skeletal muscle atrophy is frequently seen in patients with CLD. Skeletal muscle mass is an independent predictor for the development and recurrence of HCC . Skeletal muscle atrophy is also an independent prognostic factor for patients with liver cirrhosis and HCC .…”

Section: Introductionmentioning

confidence: 99%

Effects of in‐hospital exercise on liver function, physical ability, and muscle mass during treatment of hepatoma in patients with chronic liver disease

Koya

Kawaguchi

Hashida

et al. 2016

Hepatology Research

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Aims: Sarcopenia and physical disability assessed by a 6-min walking test (6MWT) are associated with poor prognosis of patients with chronic liver disease (CLD). However, CLD patients with hepatocellular carcinoma (HCC) mostly rest in bed during hospitalization. We aimed to investigate the effects of therapeutic exercise on liver function, 6MWT, and skeletal muscle mass during HCC treatment in patients with CLD. Methods:We enrolled 54 CLD patients with HCC (median age, 76 years). During hospitalization, patients performed a combination of stretching, strength training, balance practice, and endurance training (2.5-4 metabolic equivalents/20 min/day). Primary outcomes were changes from admission to discharge in ChildPugh class, 6MWT, and skeletal muscle mass. Furthermore, factors associated with skeletal muscle atrophy were analyzed by a decision-tree analysis.Results: Exercise did not worsen the Child-Pugh class. On discharge, the 6MWT ambulation distance was maintained, and heart rate variability during the 6MWT was significantly improved compared to that on admission (area under the curve 50.3 vs. 39.0 arbitrary units; P = 0.0027). Although skeletal muscle mass was significantly reduced (20.6 kg vs. 20.0 kg, P = 0.0301), branched-chain amino acid (BCAA) treatment was identified as the most distinguishable factor for minimizing muscle mass atrophy (À1.1 kg vs. À0.5 kg/hospitalization).Conclusions: Therapeutic exercise improved physical ability without worsening liver function during hospitalization for HCC treatment in CLD patients. Although exercise did not completely prevent skeletal muscle atrophy, BCAA treatment minimized the skeletal muscle atrophy. Thus, exercise with BCAA treatment may be important for the management of CLD patients with HCC.

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Sarcopenia is a risk factor for the recurrence of hepatocellular carcinoma after curative treatment

Abstract: Sarcopenia is a risk factor for recurrence in patients with HCC who were treated with curative treatment.

Cited by 89 publications

References 40 publications

Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria

Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Effects of in‐hospital exercise on liver function, physical ability, and muscle mass during treatment of hepatoma in patients with chronic liver disease

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