Published online Sep 28, 2022. doi: 10.3748/wjg.v28.i36.5324
Peer-review started: May 2, 2022
First decision: June 19, 2022
Revised: June 22, 2022
Accepted: August 30, 2022
Article in press: August 30, 2022
Published online: September 28, 2022
Processing time: 143 Days and 19.8 Hours
At the diagnosis of hepatocellular carcinoma (HCC), more than 90% of HCC patients present cirrhosis, a clinical condition often associated to malnutrition. Sarcopenia is an indirect marker of malnutrition assessable on computed tomography (CT).
To evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial (chemo)-embolization.
Patients with HCC treated by a first session of trans-arterial (chemo)embolization and an available CT scan before treatment were included. Sarcopenia was assessed using skeletal muscle index at baseline and at the first radiological assessment. Radiological response was recorded after the first session of treatment using mRECIST.
Of 225 patients treated by trans-arterial bland embolization (n = 71) or trans-arterial chemoembolization (n = 154) for HCC between 2007 and 2013, Barcelona Clinic of Liver Cancer stage was A, B, and C in 27.5%, 55%, and 16.8% of cases, respectively. Sarcopenia was present in 57.7% of the patients. Patients with sarcopenia presented a higher rate of progressive disease (19% vs 8%, P = 0.0236), a shorter progression-free survival (8.3 vs 13.2 mo, P = 0.0035), and a shorter median overall survival (19.4 mo vs 35.5 mo, P = 0.0149) compared with non-sarcopenic patients. Finally, patients whose sarcopenia appeared after first transarterial treatment had the worst prognosis (P = 0.0004).
Sarcopenia is associated with tumor progression and poor survival outcomes after trans-arterial (chemo)-embolization for HCC.
Core Tip: This work evaluated the predictive value of sarcopenia for tumor response and survival outcomes in hepatocellular carcinoma patients treated by transarterial chemoembolization or transarterial embolization. In this study, sarcopenia at imaging was observed in 57.7% of patients. It was associated with a higher rate of progressive disease and a decreased overall survival after adjustment with usual risk factors of death. Sarcopenia is an easy-to-assess radiological biomarker of poor prognosis that should be measured in order to assess prognosis and test a targeted intervention mixing nutritional support and physical activity.