Luo Pei-Jui, Chuang Kai-I, Ni Cheng-Fu, Yeh Hsiao-Yu, Wu Ming-Shun, Hsieh Yao-Yu, Kao Wei-Yu, Wu Chih-Horng
Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan.
Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2025 Jan 9. doi: 10.1016/j.jfma.2025.01.001.
To investigate the association of skeletal muscle mass and quality with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib (LEN).
In this retrospective study, LEN-treated patients with HCC were enrolled. Sarcopenia and myosteatosis were evaluated on the basis of baseline skeletal muscle index and mean muscle attenuation, respectively, on computed tomography at the L3 level. Low skeletal muscle mass (LSMM) was determined on the basis of index value, and bioinformatics tools were used to determine reliable cutoff values. Myosteatosis was defined on the basis of mean Hounsfield unit values and predefined cutoff values. A logrank test and Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS).
A total of 81 patients were included. Patients with LSMM exhibited significantly lower PFS (p = 0.003) and OS (p = 0.010) than did patients without LSMM. Patients with myosteatosis exhibited significantly lower PFS (p = 0.012) and OS (p < 0.001) than did patients without myosteatosis. In multivariate analysis adjusted for tumor extent and liver function reserve, LSMM and myosteatosis remained independent predictors of low PFS (p = 0.028, p = 0.031) and OS (p = 0.027, p = 0.001), respectively.
LSMM and myosteatosis are independent prognostic factors for PFS and OS in advanced patients with HCC who received LEN and may exert synergistic effects on these survival outcomes.
探讨接受乐伐替尼（LEN）治疗的晚期肝细胞癌（HCC）患者骨骼肌质量和质量与生存结局的相关性。
在这项回顾性研究中，纳入接受LEN治疗的HCC患者。分别根据L3水平计算机断层扫描的基线骨骼肌指数和平均肌肉衰减评估肌肉减少症和肌少脂变。根据指数值确定低骨骼肌质量（LSMM），并使用生物信息学工具确定可靠的临界值。根据平均亨氏单位值和预定义的临界值定义肌少脂变。采用对数秩检验和Cox比例风险模型比较总生存期（OS）和无进展生存期（PFS）。
共纳入81例患者。与无LSMM的患者相比，LSMM患者的PFS（p = 0.003）和OS（p = 0.010）显著更低。与无肌少脂变的患者相比，有肌少脂变的患者的PFS（p = 0.012）和OS（p < 0.001）显著更低。在针对肿瘤范围和肝功能储备进行调整的多变量分析中，LSMM和肌少脂变仍然分别是低PFS（p = 0.028，p = 0.031）和OS（p = 0.027，p = 0.001）的独立预测因素。
LSMM和肌少脂变是接受LEN治疗的晚期HCC患者PFS和OS的独立预后因素，并且可能对这些生存结局产生协同作用。
