Chen Jingjing, Huang Xueying, Wei Qiaoxin, Liu Songtao, Song Wenyan, Liu Mei
Department of Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Department of Imaging, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Front Immunol. 2025 Mar 5;16:1557839. doi: 10.3389/fimmu.2025.1557839. eCollection 2025.
Low skeletal muscle mass (LSMM) has been associated with poor prognosis in hepatocellular carcinoma (HCC) patients receiving systemic therapy. However, its impact across different treatment regimens remains unclear.
A retrospective study analyzed 714 patients with intermediate and advanced HCC, divided into immunotherapy (I, n=85), target-immunotherapy combination (I+T, n=545), and targeted therapy (T, n=84) groups based on treatment. Skeletal muscle was assessed via computed tomography (CT) at the third lumbar vertebral level (L3) before and after 3 months of treatment. LSMM was evaluated by the third lumbar skeletal muscle index (L3-SMI) using a predefined threshold. Patients were stratified by baseline values and treatment changes. Kaplan-Meier and Cox models were used to compare overall survival (OS) and progression-free survival (PFS).
There was no significant difference in the loss of muscle mass among the three groups of LSMM patients; whereas, non-LSMM(NLSMM) patients in group T lost more muscle mass than those in group I (P=0.040).In the I+T group, patients who achieved an objective response (ORR) had less muscle mass loss than those without (P=0.013), while the changes in muscle mass for patients in the I group and T group were unrelated to treatment response. Baseline or post-treatment LSMM was associated with poorer median OS, especially in the I+T group. Progressive LSMM was linked to shorter median PFS (4.9 5.7 months) and OS (9.8 16.5 months), with similar results in the I+T group (mPFS, 4.2 . 5.8 months; mOS, 9.7 16.1 months). Patients with LSMM had a higher incidence of treatment-related SAEs, particularly ascites and fatigue.
In patients with combined LSMM in hepatocellular carcinoma, muscle loss did not significantly differ between those treated with I, I+T, and T; however, T treatment contributed to muscle mass loss in NLSMM patients. Greater muscle loss correlated with poorer treatment outcomes and increased SAEs, and baseline, post-treatment, and progressive LSMM were linked to significantly worse prognoses, particularly with combined treatment regimens.
低骨骼肌质量（LSMM）与接受全身治疗的肝细胞癌（HCC）患者的不良预后相关。然而，其在不同治疗方案中的影响仍不明确。
一项回顾性研究分析了714例中晚期HCC患者，根据治疗方法分为免疫治疗组（I，n = 85）、靶向 - 免疫联合治疗组（I + T，n = 545）和靶向治疗组（T，n = 84）。在治疗前和治疗3个月后，通过计算机断层扫描（CT）在第三腰椎水平（L3）评估骨骼肌。使用预定义阈值通过第三腰椎骨骼肌指数（L3 - SMI）评估LSMM。患者根据基线值和治疗变化进行分层。采用Kaplan - Meier法和Cox模型比较总生存期（OS）和无进展生存期（PFS）。
三组LSMM患者的肌肉质量损失无显著差异；然而，T组的非LSMM（NLSMM）患者比I组的患者肌肉质量损失更多（P = 0.040）。在I + T组中，达到客观缓解（ORR）的患者比未达到的患者肌肉质量损失更少（P = 0.013），而I组和T组患者的肌肉质量变化与治疗反应无关。基线或治疗后的LSMM与较差的中位OS相关，尤其是在I + T组中。进行性LSMM与较短的中位PFS（4.9对5.7个月）和OS（9.8对16.5个月）相关，I + T组结果相似（mPFS，4.2对5.8个月；mOS，9.7对16.1个月）。LSMM患者治疗相关严重不良事件（SAEs）的发生率较高，尤其是腹水和疲劳。
在合并LSMM的肝细胞癌患者中，接受I、I + T和T治疗的患者肌肉损失无显著差异；然而，T治疗导致NLSMM患者肌肉质量损失。更大的肌肉损失与较差的治疗结果和SAEs增加相关，基线、治疗后和进行性LSMM与明显更差的预后相关，尤其是联合治疗方案。
