Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2022; 28(36): 5324-5337
Published online Sep 28, 2022. doi: 10.3748/wjg.v28.i36.5324
Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization
Gael Roth, Yann Teyssier, Maxime Benhamou, Mélodie Abousalihac, Stefano Caruso, Christian Sengel, Olivier Seror, Julien Ghelfi, Arnaud Seigneurin, Nathalie Ganne-Carrie, Elia Gigante, Lorraine Blaise, Olivier Sutter, Thomas Decaens, Jean-Charles Nault
Gael Roth, Yann Teyssier, Julien Ghelfi, Arnaud Seigneurin, Thomas Decaens, Univ. Grenoble-Alpes, Grenoble 38058, France
Gael Roth, Mélodie Abousalihac, Thomas Decaens, Department of Hepatology, Gastroenterology and Digestive Oncology, CHU Grenoble Alpes, Grenoble 38043, France
Gael Roth, Julien Ghelfi, Thomas Decaens, Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309, Grenoble 38043, France
Yann Teyssier, Christian Sengel, Julien Ghelfi, Department of Radiology, CHU Grenoble Alpes, Grenoble 38043, France
Maxime Benhamou, Olivier Seror, Olivier Sutter, Department of Radiology, CHU Avicenne-APHP, Bobigny 93000, France
Stefano Caruso, Olivier Seror, Nathalie Ganne-Carrie, Jean-Charles Nault, Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers-INSERM UMR 1138, Inserm, Université Paris, Paris 75006, France
Olivier Seror, Nathalie Ganne-Carrie, Jean-Charles Nault, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Paris 93430, France
Arnaud Seigneurin, Service d'Epidémiologie et Evaluation Médicale, CHU Grenoble Alpes, Grenoble 38043, France
Nathalie Ganne-Carrie, Elia Gigante, Lorraine Blaise, Jean-Charles Nault, Department of Hepatology, CHU Avicenne-APHP, Bobigny 93000, France
Author contributions: Roth G, Teyssier Y, Decaens T, and Nault JC equivalently contributed to this work; Roth G, Decaens T, and Nault JC contributed to the conceptualization; Roth G and Nault JC contributed to the methodology; Roth G, Teyssier Y, Benhamou M, Abousalihac M, Sengel C, Seror O, Ghelfi J, Ganne-Carrié N, Gigante E, Blaise L, Sutter O, Decaens T, and Nault JC contributed to the investigation; Roth G, Benhamou M, Teyssier Y, Abousalihac M, and Nault JC contributed to the formal analysis; Roth G, Nault JC, Seigneurin A, and Caruso S contributed to the data curation; Nault JC, Seigneurin A, and Caruso S contributed to the statistical analysis; Roth G, Teyssier Y, Benhamou M, Caruso S, Seigneurin A, Abousalihac M, Sengel C, Seror O, Ghelfi J, Ganne-Carrié N, Gigante E, Blaise L, Sutter O, Decaens T, and Nault JC contributed to the validation; Decaens T and Nault JC contributed to the resources; Roth G and Nault JC wrote the original draft; Roth G, Teyssier Y, Benhamou M, Seigneurin A, Abousalihac M, Sengel C, Seror O, Ghelfi J, Ganne-Carrié N, Gigante E, Blaise L, Sutter O, Decaens T, and Nault JC reviewed and edited the manuscript; Roth G, Decaens T, and Nault JC contributed to the supervision; all authors have read and approved the manuscript.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki. Study ethics was approved by the independent French ethic committee CERIM (Comité d’éthique de la recherche en imagerie médicale) (approval date May 25 2020; No. CRM-2004-084).
Informed consent statement: Patients gave their written consent before TACE procedures as in routine care practice. No specific consent statement was required regarding the retrospective analysis of data as they were anonymously used.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jean-Charles Nault, MD, PhD, Full Professor, Department of Hepatology, CHU Avicenne-APHP, 125 Rue de Stalingrad, Bobigny 93000, France. naultjc@gmail.com
Received: May 2, 2022
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
Abstract
BACKGROUND

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).

AIM

To evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial (chemo)-embolization.

METHODS

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.

RESULTS

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).

CONCLUSION

Sarcopenia is associated with tumor progression and poor survival outcomes after trans-arterial (chemo)-embolization for HCC.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Bland embolization; Sarcopenia; Skeletal muscle index

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.