65 岁及以上接受 TACE 的 HCC 患者中肌肉减少症和内脏肥胖的作用。
The role of muscle depletion and visceral adiposity in HCC patients aged 65 and over undergoing TACE.
机构信息
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 44-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
出版信息
BMC Cancer. 2021 Oct 30;21(1):1164. doi: 10.1186/s12885-021-08905-2.
BACKGROUND
The incidence of hepatocellular carcinoma (HCC) has been increasing among the elderly populations. Trans-arterial chemoembolization (TACE), a widely used first-line non-curative therapy for HCCs is an issue in geriatrics. We investigated the prognosis of elderly HCC patients treated with TACE and determined the factors that affect the overall survival.
METHODS
We included 266 patients who were older than 65 years and had received TACE as initial treatment for HCC. We analyzed the skeletal muscle index (SMI) and visceral-to-subcutaneous fat ratio (VSR) around the third lumbar vertebrae using computed tomography scans. Muscle depletion with visceral adiposity (MDVA) was defined by falling below the median SMI and above the median VSR value sex-specifically. We evaluated the overall survival in association with MDVA and other clinical factors.
RESULTS
The mean age was 69.9 ± 4.5 years, and 70.3% of the patients were men. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, 29, 136, and 101 patients were classified as BCLC 0, A, and B stages, respectively, and 79 (29.7%) had MDVA. During the median follow-up of 4.1 years, patients with MDVA had a shorter life expectancy than those without MDVA (P = 0.007) even though MDVA group had a higher objective response rate after the first TACE (82.3% vs. 75.9%, P = 0.035). Multivariate analysis revealed that MDVA (Hazard ratio [HR] 1.515) age (HR 1.057), liver function (HR 1.078), tumor size (HR 1.083), serum albumin level (HR 0.523), platelet count (HR 0.996), tumor stage (stage A, HR 1.711; stage B, HR 2.003), and treatment response after the first TACE treatment (HR 0.680) were associated with overall survival.
CONCLUSIONS
MDVA is a critical prognostic factor for predicting survival in the elderly patients with HCC who have undergone TACE.
背景
肝细胞癌（HCC）在老年人群中的发病率一直在上升。经动脉化疗栓塞（TACE）是 HCC 的一种广泛应用的一线非治愈性治疗方法，在老年病学中是一个问题。我们研究了接受 TACE 治疗的老年 HCC 患者的预后，并确定了影响总生存期的因素。
方法
我们纳入了 266 名年龄大于 65 岁且接受 TACE 作为 HCC 初始治疗的患者。我们使用计算机断层扫描分析了第三腰椎周围的骨骼肌指数（SMI）和内脏-皮下脂肪比（VSR）。根据性别特异性的中位数 SMI 和中位数 VSR 值，定义肌肉减少伴内脏肥胖（MDVA）为低于中位数 SMI 和高于中位数 VSR 值。我们评估了与 MDVA 和其他临床因素相关的总生存期。
结果
平均年龄为 69.9 ± 4.5 岁，70.3%的患者为男性。根据巴塞罗那临床肝癌（BCLC）分期系统，29、136 和 101 名患者分别被分为 BCLC 0、A 和 B 期，79 名（29.7%）患者存在 MDVA。在中位随访 4.1 年期间，存在 MDVA 的患者预期寿命短于不存在 MDVA 的患者（P=0.007），尽管 MDVA 组在首次 TACE 后的客观缓解率更高（82.3% vs. 75.9%，P=0.035）。多变量分析显示，MDVA（风险比[HR] 1.515）、年龄（HR 1.057）、肝功能（HR 1.078）、肿瘤大小（HR 1.083）、血清白蛋白水平（HR 0.523）、血小板计数（HR 0.996）、肿瘤分期（A 期，HR 1.711；B 期，HR 2.003）和首次 TACE 治疗后的治疗反应（HR 0.680）与总生存期相关。
结论
MDVA 是预测接受 TACE 治疗的老年 HCC 患者生存的一个关键预后因素。
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