Impact of sarcopenia on tumor response and survival outcomes in patients with hepatocellular carcinoma treated by trans-arterial (chemo)-embolization

doi:10.3748/wjg.v28.i36.5324

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World Journal of Gastroenterology

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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.

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

ARTICLE HIGHLIGHTS

Research background

At the diagnosis of hepatocellular carcinoma (HCC), more than 90% of HCC patients present a cirrhosis, a clinical condition often associated to malnutrition. Sarcopenia has been associated with a lower tumor response or poorer survival of patients undergoing various treatments such as surgery or systemic therapies. Transarterial chemoembolization is the treatment of choice for intermediate HCC and is largely used worldwide, but the impact of sarcopenia on its results was poorly studied.

Research motivation

Finding easy ways to detect sarcopenia within daily practice should benefit to patients by better characterizing their prognosis and taking their nutritional status into account in therapeutic decisions.

Research objectives

This study aimed to evaluate the prognostic value of sarcopenia in patients with HCC treated by trans-arterial (chemo)-embolization based on baseline computed tomography (CT) findings and study its impact on objective tumor response and survival outcomes.

Research methods

Sarcopenia is easy to assess on CT by measuring the skeletal muscle index. A skeletal muscle index (SMI) < 50 cm²/m² in male and < 39 cm²/m² in female patients corresponding to sarcopenia was observed in 57.7% of the patients.

Research results

Based on SMI analysis measured on baseline imaging, sarcopenia was observed in 57.7% of the patients. After full review of radiological response using mRECIST criteria, sarcopenia was associated with a higher rate of progressive disease. It was also associated with a decrease overall survival even after adjustment with usual risk factors of death.

Research conclusions

Sarcopenia is an easy-to-assess radiological biomarker of poor prognosis that should be measured in order to better assess prognosis of HCC patients.

Research perspectives

Sarcopenia should be systematically detected at baseline, and induce a targeted intervention mixing nutritional support and physical activity. Further studies are needed to assess the benefit of these strategies in HCC patients.