Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand.
Division of Medical Oncology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.
Sci Rep. 2024 Aug 20;14(1):19249. doi: 10.1038/s41598-024-70266-0.
Sarcopenia's impact on hepatocellular carcinoma (HCC) outcomes is well-documented, but the effects of pre-sarcopenia remain unclear. This study investigates the impact of pre-sarcopenia on tumor response and survival in patients with unresectable HCC undergoing transarterial chemoembolization (TACE). We retrospectively evaluated muscle volume using the SliceOmatic software in patients with unresectable HCC treated with TACE. Pre-sarcopenia was defined by Japan Society of Hepatology standards (men: 42 cm/m; women: 38 cm/m). Pre-sarcopenia and non-pre-sarcopenia groups were compared, and Cox proportional hazards model was used to identify survival-influencing variables. Subgroup analysis was conducted stratified by the tumor burden, using serum alpha-fetoprotein (AFP) levels at a diagnostic cutoff value of 200 ng/mL. Of the 100 patients, 39 had pre-sarcopenia. The presence of pre-sarcopenia was not associated with tumor complete response achievement. The median overall survival (OS) was significantly lower in the pre-sarcopenia group (18 months) than in the non-pre-sarcopenia group (30 months; log-rank P = 0.039). Subgroup analysis among 77 patients with AFP < 200 ng/mL revealed that OS was particularly poor in the pre-sarcopenia group (16 vs. 34 months; log-rank P < 0.001). Multivariate analysis identified increased AFP (adjusted hazard ratio [HR] per 10-unit increase 1.142; P < 0.001), higher Model for End-Stage Liver Disease score (adjusted HR per 1-unit increase 1.176; P < 0.001), and pre-sarcopenia (adjusted HR 2.965; P < 0.001) as predictors of shorter OS. Pre-sarcopenia is a significant predictor of increased mortality in patients with unresectable HCC undergoing TACE, especially in those with AFP < 200 ng/mL, suggesting its potential as a target for early intervention.
肌肉减少症对肝细胞癌（HCC）结局的影响已有充分记录，但预肌减少症的影响仍不清楚。本研究调查了预肌减少症对接受经动脉化疗栓塞（TACE）治疗的不可切除 HCC 患者肿瘤反应和生存的影响。我们使用 SliceOmatic 软件对接受 TACE 治疗的不可切除 HCC 患者的肌肉体积进行了回顾性评估。根据日本肝脏学会标准（男性：42cm/m；女性：38cm/m）定义预肌减少症。比较了预肌减少症组和非预肌减少症组，并使用 Cox 比例风险模型确定了影响生存的变量。根据肿瘤负荷进行了亚组分析，使用诊断截断值为 200ng/ml 的血清甲胎蛋白（AFP）水平进行分层。在 100 名患者中，有 39 名患有预肌减少症。预肌减少症的存在与肿瘤完全缓解的获得无关。预肌减少症组的中位总生存期（OS）明显低于非预肌减少症组（18 个月比 30 个月；对数秩 P=0.039）。在 AFP<200ng/ml 的 77 名患者中进行的亚组分析显示，预肌减少症组的 OS 特别差（16 个月比 34 个月；对数秩 P<0.001）。多变量分析确定 AFP 增加（每增加 10 个单位的调整后的危害比[HR]为 1.142；P<0.001）、终末期肝病模型评分较高（每增加 1 个单位的调整后的 HR 为 1.176；P<0.001）和预肌减少症（调整后的 HR 为 2.965；P<0.001）是 OS 缩短的预测因素。预肌减少症是 TACE 治疗不可切除 HCC 患者死亡率增加的重要预测因素，尤其是在 AFP<200ng/ml 的患者中，提示其可能成为早期干预的目标。
