The predictive value of sarcopenia and myosteatosis in trans-arterial (chemo)-embolization treated HCC patients

Abstract

Background: We conducted a meta-analysis to provide evidence-based results for the predictive values of sarcopenia, skeletal muscle index, psoas muscle index and the myosteatosis regarding the impact of survival outcomes and tumor response in patients treated by trans-arterial (chemo)-embolization (TAE/TACE), thereby optimizing therapeutic strategies and maximizing clinical benefits for hepatocellular carcinoma patients. Methods: Qualified studies were retrieved from PubMed, the Cochrane Library, EMBASE, and Google Scholar before June 19, 2023. We investigated the relationships between sarcopenia, SMI, PMI, myosteatosis, and the overall survival of TAE/TACE-treated hepatocellular carcinoma patients with pooling data. Results: A total of 167 studies were collected and 12 studies were finally included for analysis. The metaanalysis assisted that the sarcopenia (HR: 1.46, 95% CI: 1.30-1.64, p < 0.001), skeletal muscle index (HR: 1.48, 95% CI: 1.29-1.69, p < 0.001), and psoas muscle index (HR: 1.45, 95% CI: 1.19-1.77, p < 0.001) were significantly related to a shorter OS of hepatocellular carcinoma patients who treated by TAE/TACE. Sarcopenia significantly contributed to a lower objective response rate of TAE/TACE treated hepatocellular carcinoma patients (OR: 0.80, 95% CI: 0.65-0.98, p = 0.032). But there was no significant association between the myosteatosis and the overall survival (HR: 1.29, 95% CI: 0.74-2.25, p = 0.366). Sensitivity analysis supported the stability and dependability of above analyses conclusions. Conclusion: Sarcopenia, skeletal muscle index and psoas muscle index, are significant prognostic predictors for TAE/TACE treated hepatocellular carcinoma patients. While myosteasis does not demonstrate a prognostic impact on the overall survival of TAE/TACE treated hepatocellular carcinoma patients.

Prevalence of and Impact on the Outcome of Myosteatosis in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

“…Although the authors found that myosteatosis was predictive of a poor outcome in HCC patients (HR 1.88 95% CI 1.40–2.52, p < 0.0001), no further data on the characteristics of these patients were provided, no subgroup analysis was performed, while the association between myosteatosis with other outcomes was not assessed. A more recent meta-analysis evaluated the prognostic impact of sarcopenia and myosteatosis on HCC patients treated with TACE [ 36 ]: although sarcopenia was associated with a poor outcome, no significant association was demonstrated between the presence of myosteatosis and overall survival (HR: 1.29, 95% CI: 0.74–2.25, p = 0.366). However, in this meta-analysis [ 36 ], only two studies that examined myosteatosis were included and all HCC patients underwent TACE.…”

“…A more recent meta-analysis evaluated the prognostic impact of sarcopenia and myosteatosis on HCC patients treated with TACE [ 36 ]: although sarcopenia was associated with a poor outcome, no significant association was demonstrated between the presence of myosteatosis and overall survival (HR: 1.29, 95% CI: 0.74–2.25, p = 0.366). However, in this meta-analysis [ 36 ], only two studies that examined myosteatosis were included and all HCC patients underwent TACE. Furthermore, similar to the previous meta-analysis [ 4 ], several limitations could be mentioned, since no assessment of other outcomes was performed, while further subgroup analyses were not provided.…”