Review
Copyright ©The Author(s) 2022.
World J Gastroenterol. Jan 28, 2022; 28(4): 432-448
Published online Jan 28, 2022. doi: 10.3748/wjg.v28.i4.432
Table 1 Outcomes of hepatocellular carcinoma patients undergoing loco-regional therapy with sarcopenia
Ref.
Technique
n
Methods and outcomes
RFA
Iritani et al[15] (2012-2014, Japan) RFA217L3-SMI. B36.0 cm2/m2 for men and B29.0 cm2/m2 for women. Sarcopenia patients had lower OS than those without
Fujiwara et al[57] (2015, Japan) RFA515L3-SMI used. B36.2 cm2/m2 for men and B29.6 cm2/m2 for women. Sarcopenia was associated with a higher risk of recurrence in very early/early-stage HCC who underwent treatment with RFA.
Yuri et al[58] (2017, Japan) RFA182PMI used. 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Sarcopenia was associated with overall reduced HCC survival with no effect on recurrence.
TACE
Dodson et al[38] (2013, United States) TACE drug eluding TACE216TPA was used to assess sarcopenia. TPA of < 477 mm/m2 for men and < 338 mm/m2 for woman. Sarcopenia was independently associated with increased risk of death (lowest vs highest TPA quartile, HR = 1.84; P = 0.04)
Kobayashi et al[60] (2018, Japan)TACE102L3-SMI used. 42 cm2/m2 for men and 38 cm2/m2 for women. Change in L3-SMI was an independent prognostic factor in patients with HCC treated with TACE.
Loosen et al[61] (2019, Germany) TACE56Mean PMI was 11.81 mm/m2. Low PMI (13.39 mm/m2) had significantly lower median overall survival (491 d) compared to high PMI (1291 d)
Fujita et al[59] (2019, Japan) TACE 179PMI used. < 6.0 cm2/m2 for men and < 3.4 cm2/m2 for women. No difference was normal with low PMI and normal PMI for HCC outcomes. However, changes in PMI were significant after TACE with significant loss of liver function reserves post treatment.
TARE
Faron et al[32] (2020, Europe) TARE58MRI derived FFMA were used to predict sarcopenia. FFMA < 3582 mm2 for men and < 2301 mm2 for men. Low FFMA was associated with significantly reduced OS (197 vs 294, P = 0.02).
Studies depicting various loco-regional treatments utilized in hepatocellular carcinoma in relation to sarcopenia. RFA: Radiofrequency Ablation; TACE: Transarterial chemoembolization; TARE: Transarterial radiofrequency embolization; L3-SMI: Third lumbar vertebrae-skeletal muscle index; OS: Overall survival; HCC: Hepatocellular carcinoma; TPA: Total psoas area; FFMA: Fat-free muscle area; PMI: Psoas muscle index.
Table 2 Outcomes of hepatocellular carcinoma patients undergoing liver resection (hepatectomy) with sarcopenia over last 5 years
Ref.
Technique
n
Methods and outcomes
Otsuji et al[65] (2015, Japan)Major hepatectomy and extrahepatic bile resection256Total psoas area (TPA) was used to assess sarcopenia. TPA of < 567 mm/m2 for men and < 395 mm/m2 for woman. Length of postoperative hospital stay were longer (39 d vs 30 d, P < 0.001, high rate of liver failure (33% vs 16%), major complications (54% vs 37%), intra-abdominal abscess (29% vs 18% compared to those without sarcopenia (P < 0.05)[69].
Voron et al[110] (2015, Japan)Hepatectomy198L3-SMI used 52.4 cm2/m2 for men and 38.9 cm2/m2 for women. Sarcopenia was associated with shorter median OS (52.3 mo vs 70.3 mo; P = 0.01 and it was an independent predictor of OS and DFS.
Yabusaki et al[111] (2016, Japan) Primary hepatectomy195SMI used 43.75 cm2/m2 for men and 41.10 cm2/m2 for women. Sarcopenia was associated with poor cumulative recurrence rate (P = 0.13).
Takagi et al[113] (2016, Japan)Curative hepatectomy254L3-SMI used 46.4 cm2/m2 for men and 37.6 cm2/m2 for women. The sarcopenic group had a significantly lower 5-yr OS rate than the non-sarcopenic group (58.2% vs 82.4%, P = 0.0002). Further it was an independent predictor of poor survival (HR =2.28, P = 0.002) and poor ASA status (HR = 3.17, P = 0.001).
Kobayashi et al[21] (2019, Japan) Hepatectomy465L3-SMI used. 40.31 cm2/m2 for men and 30.88 cm2/m2 for women. Sarcopenic obesity as a significant risk factor for mortality (HR = 2.504, P = 0.005) and recurrence of HCC (HR = 2.031, P = 0.006) after hepatectomy for HCC.
Hamaguchi et al[112] (2019, Japan) Hepatectomy606L3-SMI was used to assess the sarcopenia. SMI of < 40.31 for men and 30.88 for women were used. A high visceral-to-subcutaneous adipose tissue ratio, low SMI, and high IMAC contributed to an increased risk of death (P < 0.001) and HCC recurrence (P < 0.001) in an additive manner.
Xu et al[22] (2020, China)Hepatectomy1420 Authors performed a meta-analysis of six studies and preoperative sarcopenia was significantly associated with poor OS (HR =1.58, 95%CI: 1.34-1.84, P = 0) and shorter DFS (HR =1.54, 95%CI: 1.17-2.02, P = 0.002) in patients with HCC undergoing hepatectomy[24].
Studies, techniques and outcomes to evaluate the success of liver resection in patients with sarcopenia and hepatocellular carcinoma. L3-SMI: Third lumbar vertebrae- skeletal muscle Index; OS: Overall survival; SMI: Skeletal muscle index; HR: Hazards ratio; DFS: Disease free survival. HCC: Hepatocellular carcinoma; TPA: Total psoas area; IMAC: Intramuscular adipose tissue content; PMI: Psoas muscle index.
Table 3 Outcomes of hepatocellular carcinoma patients undergoing liver transplant with sarcopenia over last 5 years
Ref.
Technique
n
Methods and outcomes
Itoh et al[114] (2016, Japan) Living-donor LT153Based on SVR, patients with low SVR were had poor prognosis than without low SVR for OS (P = 0.03) and recurrence-free survival (P = 0.01).
Carey et al[68] (2016, United States) Awaiting LT396L3-SMI used. 50 cm2/m2 for men and 39 cm2/m2 for women. Patients who died had lower SMI compared to those who survived (45.6 cm2/m2 vs 48.5 cm2/m2; P < 0.001), and SMI was associated with wait-list mortality (HR, 0.95; P < 0.001)[72].
Wada et al[67] (2017, Japan)LDLT32TPA was used. TPA of 791.6 mm2/m2 for men and 488.8 mm2/m2 for women. TPV was used to compare to TPA. Preoperative TPV is a better predictor compared to TPA in assessing post-operative risks in LDLT recipients[71].
Golse et al[70] (2017, Europe) LT256PMA, L3-SMI was used. 1561 mm2 for men and 1464 mm2 for women. One and 5-yr OS rates were significantly poorer in the sarcopenic group than in the nonsarcopenic group at 59% vs 94% and 54% vs 80%, respectively (P < 0.001). Authors concluded that pre-LT PMA might be predict 1-yr survival post-LT[74].
Van Vugt et al[69] (2017, Europe) Listed for LT585L3-SMI used. 43 to 53 cm2/m2 for men based on the BMI and 41 cm2/m2 for women. Sarcopenia was associated with waiting list mortality in liver transplant candidates with cirrhosis, particularly in patients with lower MELD scores (P < 0.001) [73].
Kim et al[71] (2018, Japan) LDLT92Height normalized psoas muscle thickness (< 15.5 mm/m) at L3. HCC recurrence risk was greater in sarcopenic patients in univariable analysis [HR = 8.06 (1.06–16.70), P = 0.044) and in multivariable analysis [HR = 9.49 (1.18–76.32), P = 0.034][75].
Chae et al[66] (2018, South Korea)LDLT408This study investigated the association between a perioperative decrease in the PMI and patient mortality after LT. A PMI decrease ≤-11.7% between the day before surgery and POD-7 was an independent predictor of patient mortality after LT[70].
Techniques, methods and outcomes to evaluate the success of liver transplantation in patients with sarcopenia and hepatocellular carcinoma. LT: Liver transplant; LDLT: Living-donor LT; SVR: Skeletal muscle mass-to-Visceral fat area ratio; TPV: Total psoas volume; PMA: Psoas muscle area; BMI: Body mass index; L3-SMI: Third lumbar vertebrae- skeletal muscle index; OS: Overall survival; SMI: Skeletal muscle index; HR: Hazards ratio; DFS: Disease free survival; HCC: Hepatocellular carcinoma; TPA: Total psoas area; PMI: Psoas muscle index.