Zhao Yan, Becce Fabio, Balmer Romain, do Amaral Ricardo H, Alemán-Gómez Yasser, Uldry Emilie, Fraga Montserrat, Tsoumakidou Georgia, Villard Nicolas, Denys Alban, Digklia Antonia, Schaefer Niklaus, Duran Rafael
Department of Liver Diseases and Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital, Northwest University, Xi'an, China.
Department of Radiology and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
Eur Radiol. 2025 Mar;35(3):1415-1427. doi: 10.1007/s00330-025-11349-y. Epub 2025 Jan 21.
To investigate baseline patient characteristics associated with the risk of computed tomography (CT)-based sarcopenia and assess whether sarcopenia and other morphometric parameters influence survival outcomes in patients with liver metastases and cholangiocarcinoma after Yttrium-90 radioembolization.
We retrospectively analyzed 120 cancer patients (mean age, 62 ± 13.3 years, 61 men) who underwent preprocedural CT. Skeletal muscle index (SMI) was measured at the L3 vertebral level to identify sarcopenia. The Cox proportional hazard model was performed to assess the prognostic value of the variables, and Kaplan-Meier analysis with log-rank text was used for overall survival (OS) assessment.
Sarcopenia was diagnosed in 70 patients (58.3%). The multivariate regression analysis demonstrated that male sex, body mass index (BMI), visceral fat radiation attenuation (VFRA), skeletal muscle radiation attenuation (SMRA), and subcutaneous fat radiation attenuation (SFRA) were associated with the incidence of sarcopenia with the odds ratio of 8.81 (95% CI, 2.09-37.1, p = 0.003), 0.64 (95% CI, 0.48-0.85, p = 0.002), 1.23 (95% CI, 1.06-1.42, p = 0.006), 0.79 (95% CI, 0.69-0.91, p = 0.001) and 0.84 (95% CI, 0.76-0.93, p = 0.001), respectively. Age, skeletal muscle index, and tumor subtypes were independent prognostic factors for OS with the hazard ratio of 1.03 (95% CI, 1.01-1.05, p = 0.01), 0.92 (95% CI, 0.86-0.99, p = 0.021) and 2.09 (95% CI, 1.31-3.33 p = 0.002), respectively. In patients with intrahepatic cholangiocarcinoma, median OS was significantly longer in the non-sarcopenic group than in the sarcopenic patient (25.9 versus 6.5 months, p = 0.029).
Male sex, BMI, VFRA, SMRA, and SFRA were associated with the incidence of sarcopenia. SMI value could be used as a biomarker for OS in patients treated with Yttrium-90 radioembolization.
Question The prognostic significance of CT-based sarcopenia and other morphometric parameters in patients with liver metastases and cholangiocarcinoma undergoing Yttrium-90 radioembolization remains unclear. Findings A high skeletal muscle index has been identified as an independent protective factor for overall survival in cancer patients treated with Yttrium-90 radioembolization. Clinical relevance The negative impact of CT-based sarcopenia has been confirmed in the context of Yttrium-90 radioembolization. Clinicians should strive to prevent the progression of sarcopenia or maintain skeletal muscle index in perioperative management.
研究与基于计算机断层扫描（CT）的肌肉减少症风险相关的患者基线特征，并评估肌肉减少症和其他形态计量学参数是否会影响钇-90放射性栓塞术后肝转移和胆管癌患者的生存结果。
我们回顾性分析了120例接受术前CT检查的癌症患者（平均年龄62±13.3岁，61例男性）。在L3椎体水平测量骨骼肌指数（SMI）以确定肌肉减少症。采用Cox比例风险模型评估变量的预后价值，并使用带有对数秩检验的Kaplan-Meier分析进行总生存期（OS）评估。
70例患者（58.3%）被诊断为肌肉减少症。多因素回归分析表明，男性、体重指数（BMI）、内脏脂肪辐射衰减（VFRA）、骨骼肌辐射衰减（SMRA）和皮下脂肪辐射衰减（SFRA）与肌肉减少症的发生率相关，比值比分别为8.81（95%CI，2.09-37.1，p=0.003）、0.64（95%CI，0.48-0.85，p=0.002）、1.23（95%CI，1.06-1.42，p=0.006）、0.79（95%CI，0.69-0.91，p=0.001）和0.84（95%CI，0.76-0.93，p=0.001）。年龄、骨骼肌指数和肿瘤亚型是OS的独立预后因素，风险比分别为1.03（95%CI，1.01-1.05，p=0.01）、0.92（95%CI，0.86-0.99，p=0.021）和2.09（95%CI，1.31-3.33，p=0.002）。在肝内胆管癌患者中，非肌肉减少症组的中位OS显著长于肌肉减少症患者（25.9个月对6.5个月，p=0.029）。
男性、BMI、VFRA、SMRA和SFRA与肌肉减少症的发生率相关。SMI值可作为接受钇-90放射性栓塞治疗患者OS的生物标志物。
问题基于CT的肌肉减少症和其他形态计量学参数在接受钇-90放射性栓塞的肝转移和胆管癌患者中的预后意义仍不清楚。发现高骨骼肌指数已被确定为接受钇-90放射性栓塞治疗的癌症患者总生存期的独立保护因素。临床意义在钇-90放射性栓塞的背景下，基于CT的肌肉减少症的负面影响已得到证实。临床医生应在围手术期管理中努力预防肌肉减少症的进展或维持骨骼肌指数。
