Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Immunol. 2024 Apr 16;15:1396927. doi: 10.3389/fimmu.2024.1396927. eCollection 2024.
Immunotherapy stands as a pivotal modality in the therapeutic landscape for the treatment of advanced hepatocellular carcinoma, yet responses vary among patients. This study delves into the potential impact of sarcopenia, myosteatosis and adiposity indicators, as well as their changes during immunotherapy, on treatment response and prognosis in patients with advanced hepatocellular carcinoma treated with immune checkpoint inhibitors.
In this retrospective analysis, 116 patients with advanced hepatocellular carcinoma receiving immune checkpoint inhibitors were recruited. Skeletal muscle, intramuscular, subcutaneous, and visceral adipose tissue were assessed by computed tomography at the level of the third lumbar vertebrae before and after 3 months of treatment. Sarcopenia and myosteatosis were evaluated by skeletal muscle index and mean muscle density using predefined threshold values. Patients were stratified based on specific baseline values or median values, along with alterations observed during the treatment course. Overall survival (OS) and progression-free survival (PFS) were compared using the log-rank test and a multifactorial Cox proportional risk model.
A total of 116 patients were recruited and divided into two cohorts, 81 patients for the training set and 35 patients for the validating set. In the overall cohort, progressive sarcopenia (=0.021) and progressive myosteatosis (=0.001) were associated with objective response rates, whereas progressive myosteatosis <0.001) was associated with disease control rates. In the training set, baseline sarcopenia, myosteatosis, and subcutaneous and visceral adipose tissue were not significantly associated with PFS and OS. In multivariate analysis adjusting for sex, age, and other factors, progressive sarcopenia(=0.002) and myosteatosis (=0.018) remained independent predictors of PFS. Progressive sarcopenia (=0.005), performance status (=0.006) and visceral adipose tissue index (=0.001) were all independent predictors of OS. The predictive models developed in the training set also had good feasibility in the validating set.
Progressive sarcopenia and myosteatosis are predictors of poor clinical outcomes in patients with advanced hepatocellular carcinoma receiving immune checkpoint inhibitors, and high baseline visceral adiposity is associated with a poorer survival.
免疫疗法在治疗晚期肝细胞癌的治疗领域中占据重要地位，然而患者之间的反应存在差异。本研究探讨了在接受免疫检查点抑制剂治疗的晚期肝细胞癌患者中，肌肉减少症、肌内脂肪增多和脂肪蓄积指标及其在免疫治疗过程中的变化对治疗反应和预后的潜在影响。
在这项回顾性分析中，招募了 116 名接受免疫检查点抑制剂治疗的晚期肝细胞癌患者。在治疗前和治疗后 3 个月，通过 CT 在第三腰椎水平评估骨骼肌、肌内、皮下和内脏脂肪组织。使用预设阈值通过骨骼肌指数和平均肌肉密度评估肌肉减少症和肌内脂肪增多。根据基线值或中位数值以及治疗过程中的变化对患者进行分层。使用对数秩检验和多因素 Cox 比例风险模型比较总生存期（OS）和无进展生存期（PFS）。
共招募了 116 名患者，分为两个队列，81 名患者用于训练集，35 名患者用于验证集。在总体队列中，进行性肌肉减少症（=0.021）和进行性肌内脂肪增多（=0.001）与客观缓解率相关，而进行性肌内脂肪增多（<0.001）与疾病控制率相关。在训练集中，基线肌肉减少症、肌内脂肪增多、皮下和内脏脂肪组织与 PFS 和 OS 无显著相关性。在调整性别、年龄和其他因素的多因素分析中，进行性肌肉减少症（=0.002）和肌内脂肪增多（=0.018）仍然是 PFS 的独立预测因素。进行性肌肉减少症（=0.005）、表现状态（=0.006）和内脏脂肪组织指数（=0.001）都是 OS 的独立预测因素。在训练集中开发的预测模型在验证集中也具有良好的可行性。
进行性肌肉减少症和肌内脂肪增多是接受免疫检查点抑制剂治疗的晚期肝细胞癌患者临床结局不良的预测因素，基线时内脏脂肪堆积较高与生存率较差相关。
