Saeki Issei, Yamasaki Takahiro, Maeda Masaki, Kawano Reo, Hisanaga Takuro, Iwamoto Takuya, Matsumoto Toshihiko, Hidaka Isao, Ishikawa Tsuyoshi, Takami Taro, Sakaida Isao
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Liver Cancer. 2018 Oct;7(4):359-371. doi: 10.1159/000487858. Epub 2018 Apr 6.
Sorafenib is a standard therapy for patients with advanced hepatocellular carcinoma (HCC). However, no predictive biomarkers of sorafenib efficacy have been discovered. Herein, we investigated the impact of body composition, such as skeletal muscle and visceral fat, on the prognosis of advanced HCC patients treated with sorafenib.
We enrolled 100 patients with advanced HCC treated with sorafenib. Prior to receiving sorafenib therapy, skeletal muscle index (SMI) and visceral fat area (VFA) were measured using computed tomography at the third lumbar vertebra and umbilical level, respectively. Muscle depletion was defined as an SMI value < 42 cm/m in men and < 38 cm/m in women. High VFA (H-VFA) was defined as a value ≥100 cm. In addition to SMI and VFA, we also analyzed various clinical parameters as potential prognostic factors.
Multivariate analysis showed that having a tumor number < 7 (hazard ratio [HR] = 0.409, < 0.001), absence of extrahepatic spread (EHS) (HR = 0.562, < 0.001), absence of muscle depletion (HR = 0.498, = 0.006), and H-VFA (HR = 0.556, = 0.031) were significant factors for long-term survival. Therefore, we evaluated the prognosis of those with no muscle depletion with H-VFA. The no muscle depletion with H-VFA group showed significantly longer survival than the other group (median survival time 15.6 vs. 11.0 months, = 0.003). Multivariate analysis showed that having a tumor number < 7 (HR = 0.454, = 0.001), absence of EHS (HR = 0.511, = 0.008), and no muscle depletion with H-VFA (HR = 0.454, = 0.002) were significant predictors of survival.
We identified no muscle depletion with H-VFA as a novel biomarker for advanced HCC patients treated with sorafenib.
索拉非尼是晚期肝细胞癌（HCC）患者的标准治疗药物。然而，尚未发现索拉非尼疗效的预测生物标志物。在此，我们研究了身体组成，如骨骼肌和内脏脂肪，对接受索拉非尼治疗的晚期HCC患者预后的影响。
我们纳入了100例接受索拉非尼治疗的晚期HCC患者。在接受索拉非尼治疗前，分别使用计算机断层扫描在第三腰椎和脐水平测量骨骼肌指数（SMI）和内脏脂肪面积（VFA）。肌肉减少定义为男性SMI值<42cm/m²，女性<38cm/m²。高VFA（H-VFA）定义为值≥100cm²。除了SMI和VFA，我们还分析了各种临床参数作为潜在的预后因素。
多变量分析显示，肿瘤数量<7个（风险比[HR]=0.409，P<0.001）、无肝外转移（EHS）（HR=0.562，P<0.001）、无肌肉减少（HR=0.498，P=0.006）和H-VFA（HR=0.556，P=0.031）是长期生存的显著因素。因此，我们评估了无肌肉减少且有H-VFA患者的预后。无肌肉减少且有H-VFA组的生存期明显长于另一组（中位生存时间15.6个月对11.0个月，P=0.003）。多变量分析显示，肿瘤数量<7个（HR=0.454，P=0.001）、无EHS（HR=0.511，P=0.008）和无肌肉减少且有H-VFA（HR=0.454，P=0.002）是生存的显著预测因素。
我们确定无肌肉减少且有H-VFA是接受索拉非尼治疗的晚期HCC患者的一种新型生物标志物。
