Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
Institute of Medical Epidemiology, Biometry and Informatics, University of Halle, Halle, Germany.
United European Gastroenterol J. 2024 Oct;12(8):1016-1027. doi: 10.1002/ueg2.12627. Epub 2024 Jul 15.
Our purpose was to assess the impact of muscle quality on overall survival (OS) in patients with advanced HCC.
This is a subanalysis of the SORAMIC trial. Overall, 363 patients were included. The SIRT/Sorafenib treatment group comprised 182 patients and the sorafenib group 181 patients. Myosteatosis was defined as skeletal muscle density (SMD) < 41 HU for patients with a body mass index up to 24.9 kg/m and <33 HU for patients with a body mass index ≥25 kg/m. Albumin-gauge score was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on clinical variables and OS, a Cox regression model was used. Hazard ratios are presented together with 95 % confidence intervals (95 % CI). Kaplan-Meier curves were used for survival analysis.
In the SIRT/sorafenib cohort, low albumin-gauge score was an independent predictor of worse OS, HR = 1.74, CI 95% (1.16-2.62), p = 0.01. In the sorafenib cohort, muscle quality parameters did not predict OS. In alcohol-induced HCC (n = 129), myosteatosis independently predicted OS, HR = 1.85, CI 95% (1.10; 3.12), p = 0.02. In viral-induced HCC (n = 99), parameters of muscle quality did not predict OS. In patients with NASH/Non-alcoholic fatty liver disease (NAFLD) induced HCC, albumin-gauge score was a strong independent predictor of worse OS in the subgroup undergoing combined treatment with SIRT and sorafenib, HR = 9.86, CI 95% (1.12; 86.5), p = 0.04.
Myosteatosis predicts independently worse OS in patients with alcohol-induced HCC undergoing combined treatment with SIRT and sorafenib. In patients with NASH/NAFLD induced HCC undergoing treatment with SIRT and sorafenib, albumin-gauge score predicts independently worse OS.
Associations between parameters of muscle quality and OS are different in accordance to the treatment strategy and etiology of HCC. These findings highlight the prognostic potential of skeletal muscle quality in patients with advanced HCC.
本研究旨在评估肌肉质量对晚期 HCC 患者总生存期（OS）的影响。
这是 SORAMIC 试验的一项亚分析。共纳入 363 例患者。SIRT/索拉非尼治疗组 182 例，索拉非尼组 181 例。肌内脂肪浸润定义为体质指数（BMI）≤24.9kg/m2 时骨骼肌密度（SMD）<41HU，BMI≥25kg/m2 时 SMD<33HU。白蛋白计评分的计算方法如下：血清白蛋白（g/dL）×SMD（HU）。为了评估肌肉质量对临床变量和 OS 的影响，采用 Cox 回归模型。风险比（HR）与 95%置信区间（95%CI）一并呈现。Kaplan-Meier 曲线用于生存分析。
在 SIRT/索拉非尼组中，低白蛋白计评分是 OS 不良的独立预测因素，HR=1.74，95%CI（1.16-2.62），p=0.01。在索拉非尼组中，肌肉质量参数不能预测 OS。在酒精性 HCC（n=129）中，肌内脂肪浸润独立预测 OS，HR=1.85，95%CI（1.10-3.12），p=0.02。在病毒性 HCC（n=99）中，肌肉质量参数不能预测 OS。在 NASH/非酒精性脂肪性肝病（NAFLD）相关 HCC 患者中，白蛋白计评分是 SIRT 和索拉非尼联合治疗亚组 OS 不良的强独立预测因素，HR=9.86，95%CI（1.12-86.5），p=0.04。
酒精性 HCC 患者接受 SIRT 和索拉非尼联合治疗时，肌内脂肪浸润独立预测 OS 不良。在接受 SIRT 和索拉非尼治疗的 NASH/NAFLD 相关 HCC 患者中，白蛋白计评分独立预测 OS 不良。
肌肉质量参数与 OS 之间的关联因 HCC 的治疗策略和病因而异。这些发现强调了骨骼肌质量在晚期 HCC 患者中的预后潜力。
