Begini Paola, Gigante Elia, Antonelli Giulio, Carbonetti Francesco, Iannicelli Elsa, Anania Giulia, Imperatrice Barbara, Pellicelli Adriano Maria, Fave Gianfranco Delle, Marignani Massimo
Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
Radiology Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
Ann Hepatol. 2017;16(1):107-114. doi: 10.5604/16652681.1226821.
Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis.
To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center.
Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively.
Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027).
This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.
背景。肌肉减少症是肝硬化患者的一种并发症及独立的死亡风险因素。
评估肌肉减少症在一家三级中心接受治疗的肝硬化合并肝细胞癌患者队列中的患病率及其对总生存期的影响。
对2004年至2014年登记并随访的92例连续性肝硬化合并肝细胞癌患者的腹部计算机断层扫描进行回顾性研究，使用软件分析第三腰椎水平肌肉的横截面积。数据根据身高进行标准化处理，计算骨骼肌指数（SMI）并测量肌肉减少症的存在情况。肌肉减少症的定义为：体重指数（BMI）≥25的女性SMI≤41 cm²/m²，男性SMI≤53 cm²/m²；BMI<25的男性和女性SMI分别≤43 cm²/m²。
诊断时的中位年龄为71.9岁（30.7 - 86.4岁），BMI为24.7（17.5 - 36.7），女性为23.1（17.5 - 36.7），男性为24.7（18.4 - 36.7），两者相当。主要为Child评分C级和BCLC A期（分别占55.4%和41.3%）；12%的病例发现有转移疾病。40.2%的病例存在肌肉减少症，主要为女性（62.9%；p = 0.005）。肌肉减少症患者的平均总生存期缩短，分别为66周（95%置信区间47至84周）和123周（95%置信区间98至150周）（p = 0.001）。在多变量分析中，肌肉减少症是总生存期缩短的一个预测因素，独立于年龄（p = 0.0027）。
这项回顾性研究表明，肝硬化合并肝细胞癌患者中肌肉减少症的患病率很高。肌肉减少症的存在被确定为总生存期缩短的独立预测因素。由于通过CT易于测量，因此应为该患者群体的预后目的确定是否存在肌肉减少症。
