Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France.
Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France.
Ann Surg Oncol. 2021 Jan;28(1):405-416. doi: 10.1245/s10434-020-09143-9. Epub 2020 Sep 23.
The aim of this study was to assess the prognostic value of liver surface nodularity (LSN) and sarcopenia from preoperative computed tomography (CT) in patients with resectable metabolic syndrome (MS)-related hepatocellular carcinoma (HCC).
Patients with MS undergoing hepatectomy for HCC between 2006 and 2018 at a single center were retrospectively analyzed. LSN and sarcopenia were assessed on preoperative CT scans, and their association with severe (Clavien-Dindo grade 3-5) postoperative complications was analyzed on multivariate analysis. The influence of LSN and sarcopenia on overall survival (OS) and recurrence-free survival (RFS) was assessed.
Overall, 110 patients (92 men [84%], mean 67.7 ± 7.7 years of age) were analyzed. Severe postoperative complications occurred in 34/110 (31%) patients. Patients with severe complications had a significantly higher LSN score (area under the receiver operating characteristic curve 0.68 ± 0.05, optimal cut-off > 2.50) and were more frequently sarcopenic (47% vs. 13% without major complications, p < 0.001). Multivariate analysis identified sarcopenia (odds ratio [OR] 6.51, 95% confidence interval [CI] 2.08-20.39; p < 0.001), LSN > 2.50 (OR 7.05, 95% CI 2.13-23.35; p < 0.001), and preoperative portal vein embolization (PVE; OR 6.06, 95% CI 1.71-21.48; p = 0.005) as independent predictors of severe complications. LSN and sarcopenia had no influence on OS. Stratification according to a combination of LSN > 2.50 and sarcopenia predicted the risk of severe postoperative complications from 7% (no sarcopenia and LSN ≤2.50) to 71% (sarcopenia and LSN > 2.50; p < 0.001), as well as RFS from 61 months (95% CI 40-82) to 17 months (95% CI 9-25; p = 0.033). Results remained significant in 52 patients without advanced fibrosis.
The combination of LSN and sarcopenia derived from routine preoperative CT seems to help predict severe postoperative complications and stratification of RFS in patients with MS and resectable HCC.
本研究旨在评估术前计算机断层扫描（CT）中肝脏表面结节（LSN）和肌肉减少症对可切除代谢综合征（MS）相关肝细胞癌（HCC）患者的预后价值。
回顾性分析 2006 年至 2018 年期间在单一中心接受肝切除术治疗 HCC 的 MS 患者。在术前 CT 扫描上评估 LSN 和肌肉减少症，并在多变量分析中分析其与严重（Clavien-Dindo 分级 3-5）术后并发症的关系。评估 LSN 和肌肉减少症对总生存（OS）和无复发生存（RFS）的影响。
总体而言，分析了 110 例患者（92 名男性[84%]，平均 67.7±7.7 岁）。34/110（31%）例患者发生严重术后并发症。严重并发症患者的 LSN 评分显著更高（受试者工作特征曲线下面积 0.68±0.05，最佳截断值>2.50），并且更常出现肌肉减少症（47%比无重大并发症的患者 13%，p<0.001）。多变量分析确定肌肉减少症（优势比[OR]6.51，95%置信区间[CI]2.08-20.39；p<0.001）、LSN>2.50（OR 7.05，95%CI 2.13-23.35；p<0.001）和术前门静脉栓塞术（PVE；OR 6.06，95%CI 1.71-21.48；p=0.005）是严重并发症的独立预测因子。LSN 和肌肉减少症对 OS 没有影响。根据 LSN>2.50 和肌肉减少症的组合进行分层，预测严重术后并发症的风险从 7%（无肌肉减少症和 LSN≤2.50）到 71%（肌肉减少症和 LSN>2.50；p<0.001），以及 RFS 从 61 个月（95%CI 40-82）到 17 个月（95%CI 9-25；p=0.033）。在没有晚期纤维化的 52 名患者中，结果仍然显著。
来自常规术前 CT 的 LSN 和肌肉减少症的组合似乎有助于预测 MS 和可切除 HCC 患者的严重术后并发症，并对 RFS 进行分层。
