Feng Yun, Yu Bingran, Liu Anxiao, Cai Chongpeng, Zhou Changming, Tong Tong, Wang Lu, Pan Qi
Department of Hepatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Front Nutr. 2025 Apr 16;12:1586202. doi: 10.3389/fnut.2025.1586202. eCollection 2025.
Primary liver cancer, predominantly hepatocellular carcinoma (HCC), is a leading cause of cancer-related deaths globally. Despite advances in targeted therapy and immunotherapy, survival rates for advanced HCC remain low. Combining hepatic artery infusion chemotherapy (HAIC) with systemic therapies shows potential, but identifying patients who benefit most is challenging. Body composition, including sarcopenia and myosteatosis, has been linked to cancer prognosis, but its role in HCC patients receiving HAIC with targeted and immunotherapies is unclear.
This retrospective study analyzed 158 HCC patients treated with HAIC, tyrosine kinase inhibitors, and anti-PD-1 immunotherapy from January 2021 to October 2024. Body composition was assessed via CT scans at the L3 level, with sarcopenia defined by skeletal muscle index (SMI) and myosteatosis by skeletal muscle density (SMD). Progression-free survival (PFS) and overall survival (OS) were evaluated, and Cox regression analyses identified prognostic factors.
Sarcopenia cutoffs were 47.1 cm/m (males) and 38.2 cm/m (females); myosteatosis cutoffs were 40.8 HU (males) and 38.9 HU (females). Sarcopenic patients had lower BMI ( < 0.001) and higher ALBI scores ( = 0.006). Tumor response rates (ORR 53.4%, DCR 77.9%) were similar between sarcopenic and non-sarcopenic groups ( = 0.531 and = 0.699). Myosteatosis showed no significant differences in ORR (54.0%) or DCR (77.0%) ( = 0.693 and = 0.872). Median PFS did not differ between sarcopenic (9.53 months) and non-sarcopenic (13.87 months) patients ( = 0.536). However, sarcopenic patients had significantly shorter OS (20.80 vs. 35.97 months, = 0.005). Myosteatosis also correlated with shorter OS (20.80 vs. 35.97 months, = 0.021). Multivariate analysis identified sarcopenia as an independent risk factor for OS (HR: 0.527, = 0.017), alongside AFP levels and tumor number.
Sarcopenia and myosteatosis predict poor prognosis in HCC patients receiving HAIC with targeted therapy and immunotherapy. Sarcopenia is an independent risk factor for OS, highlighting the importance of body composition in prognosis. No significant associations were found between body composition and tumor response or PFS.
原发性肝癌，主要是肝细胞癌（HCC），是全球癌症相关死亡的主要原因。尽管靶向治疗和免疫治疗取得了进展，但晚期HCC的生存率仍然很低。肝动脉灌注化疗（HAIC）与全身治疗相结合显示出潜力，但确定最能获益的患者具有挑战性。身体组成，包括肌肉减少症和肌脂肪变性，与癌症预后相关，但其在接受HAIC联合靶向和免疫治疗的HCC患者中的作用尚不清楚。
这项回顾性研究分析了2021年1月至2024年10月期间接受HAIC、酪氨酸激酶抑制剂和抗PD-1免疫治疗的158例HCC患者。通过L3水平的CT扫描评估身体组成，肌肉减少症通过骨骼肌指数（SMI）定义，肌脂肪变性通过骨骼肌密度（SMD）定义。评估无进展生存期（PFS）和总生存期（OS），并通过Cox回归分析确定预后因素。
肌肉减少症的临界值男性为47.1cm/m，女性为38.2cm/m；肌脂肪变性的临界值男性为40.8HU，女性为38.9HU。肌肉减少症患者的BMI较低（<0.001），ALBI评分较高（=0.006）。肌肉减少症组和非肌肉减少症组之间的肿瘤缓解率（ORR 53.4%，DCR 77.9%）相似（=0.531和=0.699）。肌脂肪变性在ORR（54.0%）或DCR（77.0%）方面无显著差异（=0.693和=0.872）。肌肉减少症患者和非肌肉减少症患者的中位PFS无差异（9.53个月对13.87个月，=0.536）。然而，肌肉减少症患者的OS明显较短（20.80对35.97个月，=0.005）。肌脂肪变性也与较短的OS相关（20.80对35.97个月，=0.021）。多因素分析确定肌肉减少症是OS的独立危险因素（HR：0.527，=0.017），同时还有AFP水平和肿瘤数量。
肌肉减少症和肌脂肪变性预示着接受HAIC联合靶向治疗和免疫治疗的HCC患者预后不良。肌肉减少症是OS的独立危险因素，突出了身体组成在预后中的重要性。未发现身体组成与肿瘤缓解或PFS之间存在显著关联。
