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Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2022; 28(4): 432-448
Published online Jan 28, 2022. doi: 10.3748/wjg.v28.i4.432
Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions
Abhilash Perisetti, Hemant Goyal, Rachana Yendala, Saurabh Chandan, Benjamin Tharian, Ragesh Babu Thandassery
Abhilash Perisetti, Benjamin Tharian, Department of Internal Medicine, Gastroenterology and Hepatology Division, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Abhilash Perisetti, Department of Interventional Oncology and Surgical Endoscopy, Parkview Health, Fort Wayne, IN 46825, United States
Hemant Goyal, Department of Internal Medicine, The Wright Center for Graduate Medical Education, The Wright Center for Graduate Medical Education, Scranton, PA 18501, United States
Rachana Yendala, Department of Hematology and Oncology, Conway Regional Medical Center, Conway, AR 72034, United States
Saurabh Chandan, Department of Internal Medicine, Gastroenterology and Hepatology Division, CHI Creighton University Medical Center, Omaha, NE 68107, United States
Ragesh Babu Thandassery, Department of Medicine, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, United States
Author contributions: Abhilash P and Thandassery R contributed to the conception, design, and literature search; Abhilash P drafted the manuscript; Goyal H performed a thorough literature search and modified the manuscript; Rest of all authors critically revised and edited the manuscript, and approved the final version.
Conflict-of-interest statement: None of the authors have no conflicts of interest.
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 Non Commercial (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: Abhilash Perisetti, FACP, MBBS, MD, Academic Fellow, Department of Internal Medicine, Gastroenterology and Hepatology Division, University of Arkansas for Medical Sciences, 4301 W Markham St., Little Rock, AR 72205, United States. abhilash.perisetti@gmail.com
Received: April 19, 2021
Peer-review started: April 19, 2021
First decision: June 23, 2021
Revised: June 29, 2021
Accepted: January 11, 2022
Article in press: January 11, 2022
Published online: January 28, 2022
Processing time: 278 Days and 2.1 Hours
Abstract

Liver cancer is the second most occurring cancer worldwide and is one of the leading causes of cancer-related deaths. Hepatocellular carcinoma (HCC) is the most common (80%-90%) type among malignant liver cancers. Sarcopenia occurs very early in HCC and can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional, systemic, and transplant management. Multiple prognostic stating systems have been developed in HCC, such as Barcelona Clinic Liver Cancer, Child-Pugh score and Albumin-Bilirubin grade. However, the evaluation of patients’ performance status is a major limitation of these scoring systems. In this review, we aim to summarize the current knowledge and recent advances about the role of sarcopenia in cirrhosis in general, while focusing specifically on HCC. Additionally, the role of sarcopenia in predicting clinical outcomes and prognostication in HCC patients undergoing loco-regional therapies, liver resection, liver transplantation and systematic therapy has been discussed. A literature review was performed using databases PubMed/MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL on April 1, 2021, to identify published reports on sarcopenia in HCC. Sarcopenia can independently predict HCC-related mortality especially in patients undergoing treatments such as loco-regional, surgical liver transplantation and systemic therapies. Basic research is focused on evaluating a balance of anabolic and catabolic pathways responsible for muscle health. Early clinical studies have shown promising results in methods to improve sarcopenia in HCC which can potentially increase prognosis in these patients. As sarcopenia occurs very early in HCC, it can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional, systemic, and transplant management. Further, sarcopenia measurement can obviate the confounding caused by the abdominal ascites in these patients. The use of sarcopenia can add to the existing scoring systems to better prognosticate the HCC.

Keywords: Sarcopenia; Skeletal muscle; Hepatocellular carcinoma; Cirrhosis; Outcomes; Liver cancer

Core Tip: Sarcopenia is a condition defined by the loss of skeletal muscle mass, quality and strength. It is commonly seen as a part of normal aging but can also be noted in multiple conditions such as chronic inflammation, cancers and use of drugs. Sarcopenia is common in liver cirrhosis and is associated with overall poor outcomes (disease-free survival). Recently, the adverse effects of sarcopenia in hepatocellular carcinoma (HCC) has been an area of intense interest. Altered bio-impedence and rapid muscle loss in liver diseases could alter skeletal muscle strength in these patients. Additionally, development of tumor-related cytokines can accelerate the sarcopenia progression which could provide insights into disease progression and response to various therapeutic options. While multiple scoring systems are available to evaluate the HCC progression, sarcopenia provides an additional functional status tool to further refine these systems. In this article, we summarize the role of sarcopenia in HCC progression and changes during locoregional and systemic treatments.