Division of Interventional Radiology, Department of Radiology, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY, 10016, USA.
Department of Radiology, Denver Health, 777 Bannock St., Pavilion A, Denver, CO, 80204, USA.
Cardiovasc Intervent Radiol. 2021 Oct;44(10):1561-1569. doi: 10.1007/s00270-021-02874-6. Epub 2021 Jun 4.
To evaluate the influence of sarcopenia on survival in patients with hepatocellular carcinoma (HCC) treated with Y radioembolization.
This single-center retrospective cohort study analyzed 82 consecutive patients (65 men and 17 women, mean age 65 years, range 31-83 years) with HCC treated with Y radioembolization between December 2013 and December 2017. Sarcopenia was assessed on pre-procedure MRI performed within 100 days prior to Y radioembolization by segmenting the paraspinal musculature at the level of the superior mesenteric artery origin and subtracting fat-intensity pixels to yield fat-free muscle area (FFMA). Sarcopenia was defined as FFMA ≤31.97 cm for men and ≤28.95 cm for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records.
Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days-58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease.
Sarcopenia was associated with increased 180-day and 1-year mortality in HCC patients undergoing Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.
评估原发性肝癌（HCC）患者接受 Y 放射性栓塞治疗后肌肉减少症对生存的影响。
本单中心回顾性队列研究分析了 2013 年 12 月至 2017 年 12 月期间接受 Y 放射性栓塞治疗的 82 例连续 HCC 患者（65 名男性和 17 名女性，平均年龄 65 岁，范围 31-83 岁）。在 Y 放射性栓塞治疗前 100 天内进行的 MRI 上评估肌肉减少症，通过在肠系膜上动脉起源处的脊柱旁肌肉进行分段，并减去脂肪强度像素以获得无脂肪肌肉面积（FFMA）。肌肉减少症定义为男性的 FFMA ≤31.97cm，女性的 FFMA ≤28.95cm。使用医疗和公共讣告记录评估初始治疗后 90 天、180 天、1 年和 3 年的生存情况。
30%（25/82）的患者存在肌肉减少症。男性中有 49%（32/65）和女性中有 71%（8/17）死亡（平均随访 19.6 个月，范围 21 天-58 个月）。发现肌肉减少症患者 180 天（31.8% vs. 8.9%）和 1 年（68.2% vs. 21.2%）死亡率增加。肌肉减少症是调整 BCLC 分期后的死亡率的独立预测因素，亚组分析表明，肌肉减少症是 BCLC 分期 B 疾病患者死亡率增加的独立预测因素。
肌肉减少症与 HCC 患者接受 Y 放射性栓塞治疗后 180 天和 1 年死亡率增加相关。肌肉减少症是调整 BCLC 分期后的生存的独立预测因素，BCLC 分期 B 患者有和没有肌肉减少症的生存曲线存在显著差异。
