Department of General, Visceral and Transplant Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
Institute of Medical Statistics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
Hepatobiliary Pancreat Dis Int. 2019 Feb;18(1):28-37. doi: 10.1016/j.hbpd.2018.07.008. Epub 2018 Jul 26.
Hepatocellular carcinoma is the most common innate liver tumor. Due to improved surgical techniques, even extended resections are feasible, and more patients can be treated with curative intent. As the liver is the central metabolic organ, preoperative metabolic assessment is crucial for risk stratification. Sarcopenia, obesity and sarcopenic obesity characterize body composition and metabolic status. Here we present the impact of body composition on survival after liver resection in patients with hepatocellular carcinoma.
A retrospective database analysis of 70 patients who were assigned for liver resection due to hepatocellular carcinoma was conducted. For assessment of sarcopenia and obesity, skeletal muscle surface area was measured at lumbar vertebra 3 level (L3) in preoperative four-phase contrast enhanced abdominal CT scans, and L3 muscle index and body fat percentage were calculated.
Univariate analysis comparing the survival curves using the score test demonstrated superior postoperative overall survival for sarcopenic (P = 0.035) and sarcopenic obese (P = 0.048) patients as well as a trend favoring obese (P = 0.130) subjects. Whereas multivariate analysis could not identify significant difference in postoperative survival regarding sarcopenia, obesity or sarcopenic obesity. Only large tumor size, multifocal disease and male gender were risk factors for long-term survival.
Sarcopenia, obesity and sarcopenic obesity are indeed no risk factors for poor postoperative survival in this study. Our data do not support the evaluation of sarcopenia, obesity and sarcopenic obesity before liver resection in hepatocellular carcinoma patients.
肝细胞癌是最常见的原发性肝脏肿瘤。由于手术技术的提高，即使是扩大的切除术也变得可行，更多的患者可以接受根治性治疗。由于肝脏是中央代谢器官，术前代谢评估对于风险分层至关重要。肌肉减少症、肥胖和肌少性肥胖症是身体成分和代谢状态的特征。在这里，我们介绍了身体成分对肝细胞癌患者肝切除术后生存的影响。
对因肝细胞癌接受肝切除术的 70 例患者进行回顾性数据库分析。为了评估肌肉减少症和肥胖症，在术前四期增强腹部 CT 扫描中测量第 3 腰椎（L3）的骨骼肌表面积，并计算 L3 肌肉指数和体脂百分比。
使用评分检验比较生存曲线的单因素分析表明，肌肉减少症（P=0.035）和肌少性肥胖症（P=0.048）患者的术后总体生存率更高，肥胖症（P=0.130）患者也有倾向。然而，多因素分析未能确定肌肉减少症、肥胖症或肌少性肥胖症与术后生存之间的显著差异。只有肿瘤较大、多发病灶和男性是长期生存的危险因素。
在这项研究中，肌肉减少症、肥胖症和肌少性肥胖症确实不是术后生存不良的危险因素。我们的数据不支持在肝细胞癌患者肝切除术前评估肌肉减少症、肥胖症和肌少性肥胖症。
