Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Liver Cancer (HCC) Study Group Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
Hepatol Commun. 2023 Sep 15;7(10). doi: 10.1097/HC9.0000000000000261. eCollection 2023 Oct 1.
Sarcopenia is a common problem in patients with HCC. We aimed to evaluate the prognostic and predictive value of baseline transversal psoas muscle thickness (TPMT) measurement in patients with HCC undergoing immunotherapy.
HCC patients treated with programmed death ligand 1-based therapies between June 2016 and October 2022 at the Vienna General Hospital (n = 80) and the Hôpital Beaujon Clichy (n = 96) were included and followed until April 2023. TPMT at the level of the third lumbar vertebra was measured independently by 2 radiologists to evaluate interreader reliability. TPMT <12 mm/m in men and <8 mm/m in women indicated sarcopenia.
Overall, 176 patients (age: 66.3±11.7 y; male: n=143, 81%, Barcelona-Clinic Liver Cancer C: n=121, 69%) were included, of which 131 (74%) exhibited cirrhosis. Interreader agreement for the diagnosis of sarcopenia based on TPMT was 92.6%, and Cohen κ showed a "strong agreement" [κ = 0.84 (95% CI: 0.75-0.92)]. Sarcopenia, present in 58 patients (33%), was associated with shorter median overall survival [7.2 (95% CI: 5.0-9.5) vs. 22.6 (95% CI: 16.4-28.8 months); p < 0.001] and median progression-free survival [3.4 (95% CI: 0.2-6.8) vs. 7.9 (95% CI: 5.8-9.9 months), p = 0.001], and an independent predictor of overall [adjusted HR: 1.63 (95% CI: 1.07-2.48)] and progression-free mortality [adjusted HR: 1.54 (95% CI: 1.06-2.23)] in multivariable analyses. The objective response rate [evaluable in 162 subjects (92.0%)] per modified Response Evaluation Criteria In Solid Tumors (mRECIST) in patients with and without sarcopenia was 22% and 39%, respectively (p = 0.029). Survival and radiological responses were worse in patients with sarcopenia and systemic inflammation [median overall survival: 6.1 (95% CI: 3.6-8.6) mo; median progression-free survival: 2.8 (95% CI: 2.1-3.4) mo; objective response rate=16%; disease control rate=39%].
Evaluation of sarcopenia using TPMT measurement is reliable and identifies HCC patients with a dismal prognosis and response to immunotherapy.
在 HCC 患者中，肌肉减少症是一个常见问题。我们旨在评估 HCC 患者接受免疫治疗时基线横断位竖脊肌厚度（TPMT）测量的预后和预测价值。
纳入 2016 年 6 月至 2022 年 10 月在维也纳总医院（n = 80）和克利希博蒙医院（n = 96）接受基于程序性死亡配体 1 治疗的 HCC 患者，并随访至 2023 年 4 月。由 2 名放射科医生独立测量第 3 腰椎水平的 TPMT，以评估读者间的可靠性。男性 TPMT <12mm/m 和女性 TPMT <8mm/m 提示肌肉减少症。
共有 176 名患者（年龄：66.3±11.7y；男性：n=143，81%，巴塞罗那-临床肝癌 C：n=121，69%）入组，其中 131 名（74%）存在肝硬化。基于 TPMT 诊断肌肉减少症的读者间一致性为 92.6%，Cohen κ 显示“强一致性”[κ=0.84（95%CI：0.75-0.92)]。58 名（33%）患者存在肌肉减少症，中位总生存期更短[7.2（95%CI：5.0-9.5）与 22.6（95%CI：16.4-28.8 个月）；p<0.001]，无进展生存期更短[3.4（95%CI：0.2-6.8）与 7.9（95%CI：5.8-9.9 个月）；p=0.001]，且是多变量分析中总生存期[调整后的 HR：1.63（95%CI：1.07-2.48）]和无进展生存期[调整后的 HR：1.54（95%CI：1.06-2.23）]死亡的独立预测因素。根据改良实体瘤反应评价标准（mRECIST）评估的客观缓解率[可评估 162 名患者（92.0%）]在肌肉减少症患者和无肌肉减少症患者中分别为 22%和 39%（p=0.029）。肌肉减少症和全身炎症患者的生存和影像学反应更差[中位总生存期：6.1（95%CI：3.6-8.6）mo；中位无进展生存期：2.8（95%CI：2.1-3.4）mo；客观缓解率=16%；疾病控制率=39%]。
使用 TPMT 测量评估肌肉减少症是可靠的，可以识别预后不良和对免疫治疗有反应的 HCC 患者。
