1
|
Cespiati A, Smith D, Lombardi R, Fracanzani AL. The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes. Cancers (Basel) 2024; 16:2315. [PMID: 39001378 PMCID: PMC11240545 DOI: 10.3390/cancers16132315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/28/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) represents a major global health concern, characterized by evolving etiological patterns and a range of treatment options. Among various prognostic factors, sarcopenia, characterized by loss of skeletal muscle mass, strength, and function, has emerged as a pivotal contributor to HCC outcomes. Focusing on liver transplantation, surgical resection, locoregional treatments, and systemic therapies, this review aims to analyze the impact of sarcopenia on HCC treatment outcomes, shedding light on an underexplored subject in the pursuit of more personalized management. METHODS A comprehensive literature review was conducted by searching peer-reviewed articles on sarcopenia and treatment outcomes in patients with HCC from inception up to October 2023. RESULTS Sarcopenia was found to be prevalent among HCC patients, exhibiting different occurrence, possibly attributable to diverse diagnostic criteria. Notably, despite variations in studies utilizing skeletal muscle indices, sarcopenia independently correlated with lower overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) across surgical (both transplantation and resection), locoregional, and systemic therapies, including tyrosine-kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs). Moreover, a link between sarcopenia and increased rate and severity of adverse events, particularly in surgery and TKIs recipients, and larger tumor size at diagnosis was observed. While baseline sarcopenia negatively influenced treatment outcomes, alterations in muscle mass post-treatment emerged as primary determinants of reduced OS. CONCLUSIONS Sarcopenia, either present before or after HCC treatment, negatively correlates with response to it, across all etiologies and therapeutic strategies. Although only a few studies have evaluated the impact of supervised physical activity training on muscle mass and OS after HCC treatment, it is crucial to evaluate the presence of sarcopenia before treatment initiation, to better stratify patients' prognosis, thus performing a more tailored approach, and identify therapies able to restore muscle mass in HCC patients. Conversely, the impact of sarcopenia on HCC recurrence and extrahepatic spread remains inadequately explored.
Collapse
Affiliation(s)
- Annalisa Cespiati
- SC Medicina ad Indirizzo Metabolico, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; (D.S.); (R.L.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Daniel Smith
- SC Medicina ad Indirizzo Metabolico, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; (D.S.); (R.L.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Rosa Lombardi
- SC Medicina ad Indirizzo Metabolico, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; (D.S.); (R.L.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Anna Ludovica Fracanzani
- SC Medicina ad Indirizzo Metabolico, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; (D.S.); (R.L.); (A.L.F.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| |
Collapse
|
2
|
Sun W, Yin X, Liu X, Wei J, Yu M, Li W, Ding X, Chen J. The clinical significance of sarcopenia in patients with hepatocellular carcinoma treated with lenvatinib and PD-1 inhibitors. Front Immunol 2024; 15:1380477. [PMID: 38698848 PMCID: PMC11063286 DOI: 10.3389/fimmu.2024.1380477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Background and aim Sarcopenia has gained considerable attention in the context of hepatocellular carcinoma, as it has been correlated with a poorer prognosis among patients undergoing sorafenib or lenvatinib treatment for hepatocellular carcinoma (HCC). The clinical significance of sarcopenia in first-line advanced HCC patients treated with lenvatinib and programmed death-1 (PD-1) inhibitors needs to be clarified. Methods Sarcopenia was diagnosed using CT (Computed tomography) or MRI (Magnetic Resonance Imaging), with the psoas muscle index (PMI) as the surrogate marker. Patients were grouped based on sarcopenia presences, and a comparative analysis examined characteristics, adverse events, and prognosis. The Cox regression analysis was applied to identify independent prognostic factors for survival, while nomograms were constructed to predict 1-year survival. Results Among 180 patients, 46 had sarcopenia. Patients with baseline sarcopenia demonstrated significantly inferior median progression-free survival (mPFS) (3.0 vs. 8.3 months) and median overall survival (mOS) (7.3 vs. 21.6 months). The same results for mPFS (3.3 vs. 9.2 months) and mOS (9.4 vs. 24.2 months) were observed in patients who developed sarcopenia after treatment. Furthermore, significantly higher grade 3 or higher adverse events (AEs) (73.91% vs 41.79%, p<0.001) were recorded in the sarcopenia group compared to the non-sarcopenia group. In the multivariate analysis, distant metastasis, elevated PLR and CRP levels, and low PMI remained independent predictive factors for poor OS. Additionally, skeletal muscle loss remained a significant independent risk factor for PFS. We developed a nomogram incorporating these four indicators, which predicted 12-month survival with a C-index of 0.853 (95% CI, 0.791 - 0.915), aligning well with actual observations. Conclusion The prognosis of patients with HCC and sarcopenia is significantly worse when treated with lenvatinib and PD-1 inhibitors. The combination regimen of lenvatinib plus PD-1 inhibitors should be cautiously recommended due to the inferior prognosis and higher AEs.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Xiaoyan Ding
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinglong Chen
- Department of Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Esposto G, Borriello R, Galasso L, Termite F, Mignini I, Cerrito L, Ainora ME, Gasbarrini A, Zocco MA. Ultrasound Evaluation of Sarcopenia in Patients with Hepatocellular Carcinoma: A Faster and Easier Way to Detect Patients at Risk. Diagnostics (Basel) 2024; 14:371. [PMID: 38396410 PMCID: PMC10887735 DOI: 10.3390/diagnostics14040371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The condition of sarcopenia, defined as a progressive loss of musculoskeletal mass and muscular strength, is very common in patients with hepatocellular carcinoma (HCC) and presents a remarkable association with its prognosis. Thus, the early identification of sarcopenic patients represents one of the potential new approaches in the global assessment of HCC, and there is increasing interest regarding the potential therapeutic implications of this condition. The gold standard for the quantification of muscle mass is magnetic resonance imaging (MRI) or computed tomography (CT), but these techniques are not always feasible because of the high-cost equipment needed. A new possibility in sarcopenia identification could be muscle ultrasound examination. The measurement of specific parameters such as the muscle thickness, muscular fascicles length or pennation angle has shown a good correlation with CT or MRI values and a good diagnostic accuracy in the detection of sarcopenia. Recently, these results were also confirmed specifically in patients with chronic liver disease. This review summarizes the role of imaging for the diagnosis of sarcopenia in patients with HCC, focusing on the advantages and disadvantages of the diagnostic techniques currently validated for this aim and the future perspectives for the identification of this condition.
Collapse
Affiliation(s)
- Giorgio Esposto
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Raffaele Borriello
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Linda Galasso
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Fabrizio Termite
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Irene Mignini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Lucia Cerrito
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Maria Elena Ainora
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| | - Maria Assunta Zocco
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 20123 Rome, Italy
| |
Collapse
|
4
|
Yang H, Cong T, Luo Y, Yang C, Ren J, Li X. Prognostic Effect of Sarcopenia in Hepatocellular Carcinoma Patients Targeted with Interventional Therapy Combined with Immunotherapy and Targeted Therapy. J Hepatocell Carcinoma 2024; 11:175-189. [PMID: 38283695 PMCID: PMC10822115 DOI: 10.2147/jhc.s444530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024] Open
Abstract
Objective To investigated the association between sarcopenia and the prognosis and adverse events of hepatocellular carcinoma (HCC) patients undergoing interventional therapy combined with immunotherapy and targeted therapy. Methods Between January 2019 and December 2022, patients with unresectable HCC who received interventional therapy combined with immunotherapy and targeted therapy were included in this study. Total skeletal muscle area at the L3 level was normalized for height in m2 as the skeletal muscle index (SMI). All patients were divided into low and high SMI group according to the median SMI. Results Ninety-six consecutive patients were included eventually, with 49 patients in the high-SMI group and 47 patients in the low-SMI group. In the low-SMI group, the median overall survival (OS) was 459.00 days (95% CI, 334.76-583.24 days), and the 3-, 6-, and 12-month OS rates were 100%, 89.4% and 68.1%, respectively. In the high-SMI group, the median OS was not reached, and the 3-, 6-, and 12-month OS rates were 100%, 98% and 79.5%, respectively (p<0.05). SMI and Barcelona Clinic Liver Cancer (BCLC) C stage were independent prognostic factors for OS (p<0.05). In the low-SMI group, 26 patients had treatment-related adverse events (TRAEs), resulting in dose adjustment or treatment suspension for 10 patients. In the high-SMI group, 33 patients had TRAEs, and 18 patients received dose adjustment or treatment suspension; the between-group difference was nonsignificant (p>0.05). Conclusion SMI is associated with the prognosis of HCC patients receiving interventional therapy combined with immunotherapy and targeted therapy, and sarcopenia is an independent risk factor for OS. However, sarcopenia does not seem to predict the occurrence of adverse events.
Collapse
Affiliation(s)
- Hongcai Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Tianhao Cong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Yingen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Chao Yang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Jinrui Ren
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| |
Collapse
|
5
|
Li X, Huang X, Lei L, Tong S. Impact of sarcopenia and sarcopenic obesity on survival in patients with primary liver cancer: a systematic review and meta-analysis. Front Nutr 2023; 10:1233973. [PMID: 37927508 PMCID: PMC10620805 DOI: 10.3389/fnut.2023.1233973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Sarcopenia and sarcopenic obesity are associated with an increased possibility of adverse clinical outcomes; however, the effects of sarcopenia and sarcopenic obesity on patients with primary liver cancer remain controversial. Therefore, the present study aimed to determine the impact of sarcopenia and sarcopenic obesity on survival in patients with primary liver cancer. Methods We searched studies published in English in PubMed, Embase, Web of Science, and Cochrane Library databases up to 13 November 2022. Cohort studies that reported the association among sarcopenia, sarcopenic obesity, and patient survival were included. Results A total of 64 cohort studies with data on 11,970 patients with primary liver cancer were included in the meta-analysis. Sarcopenia was associated with poor overall survival in patients with primary liver cancer [adjusted hazard ratio (HR) 2.11, 95% confidence interval (CI): 1.89-2.36, P < 0.0001], with similar findings for sarcopenic obesity (adjusted HR: 2.87, 95% CI: 2.23-3.70, P < 0.0001). Sarcopenia was also associated with poor overall survival across the subgroups analyzed by ethnicity, type of liver cancer, treatment modalities, method used to define sarcopenia, and etiology of liver cancer. We also found a negative correlation among sarcopenia, sarcopenic obesity, and recurrence-free/disease-free survival (adjusted HR: 1.73, 95% CI: 1.50-1.99, P < 0.001; adjusted HR: 2.28, 95% CI: 1.54-3.35, P < 0.001, respectively). Conclusion Sarcopenia and sarcopenic obesity were significantly associated with poor overall survival and recurrence-free/disease-free survival in patients with primary liver cancer. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378433, PROSPERO [42022378433].
Collapse
Affiliation(s)
- Xuanmei Li
- Department of Infectious Diseases, Department of Clinical Nutrition, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xue Huang
- Department of Ultrasound, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lifu Lei
- Department of Clinical Nutrition, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shiwen Tong
- Department of Clinical Nutrition, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| |
Collapse
|
6
|
Siu AHY, Holyland M, Carey S, Steffens D, Ansari N, Koh CE. Is the measurement of sarcopenia associated with oncological disease in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy? ANZ J Surg 2023; 93:2186-2191. [PMID: 37525364 DOI: 10.1111/ans.18645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Peritoneal malignancies are challenging cancers to manage. While cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC), may offer a cure, it is a radical procedure associated with significant morbidity. Pre-emptive identification of deconditioned patients for optimization may mitigate surgical risk. However, the difficulty lies in identifying a cost-effective predictive tool. Recently, there has been interest in sarcopenia, which may occur due to malignancy. The purpose of this study was to assess the utility of sarcopenia at predicting post-operative outcomes. METHODS A quaternary-centre retrospective study of CRS and HIPEC patients (2017-2020), were conducted to determine the association between pre-operative sarcopenia on oncological (peritoneal carcinomatosis index (PCI)) and surgical outcomes (complications). Sarcopenia from lumbar CT-images were measured using Slice-o-matic™. Statistical differences were analysed using Mann-Whitney U and Chi-squared test. RESULTS Cohort analysis (n = 94) found 40% had sarcopenia, majority were female (53.2%), and average age of 55 years. The major pathologies was colorectal cancer (n = 39, 41.5%), appendix adenocarcinoma (n = 21, 22.3%), and pseudomyxoma peritonei (PMP) (n = 19, 20.2%). Sarcopenia was associated with decreased weight, 72.7 versus 82.2 kg (P = 0.014) and shorter survival, 1.4 versus 2.1 years (95% CI, 1.09-3.05, P = 0.032). Median PCI (excluding PMP) was 11 (6-18) and median PCI (only PMP) was 25 (11-32). Post-operatively, sarcopenia patients experienced more complications (72.5% vs. 64.8%, P = 0.001). CONCLUSION Pre-emptive identification of sarcopenia may be a useful prognostic indicator and predictor of post-operative outcomes in CRS and HIPEC. For oncological patients, sarcopenia may be an indicator of patients requiring targeted pre-operative rehabilitation, or advanced disease requiring further treatment.
Collapse
Affiliation(s)
- Adrian Hang Yue Siu
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Holyland
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sharon Carey
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Yang LS, Yan LJ, Yan YC, Ding ZN, Liu H, Tan SY, Dong ZR, Wang DX, Li T. Regional and sex differences in the mortality risk associated with primary liver cancer in obesity: A systematic review and meta-analysis. Nutrition 2023; 113:112097. [PMID: 37406391 DOI: 10.1016/j.nut.2023.112097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Obesity has increasingly become a prominent public health problem. Although some studies have shown that obesity is associated with the risk for primary liver cancer (PLC)-related mortality, the regional and sex differences are not clear. The aim of this meta-analysis was to further elucidate the influence of obesity on PLC prognosis from multiple aspects. METHODS This study used a systematic literature search on PubMed, Embase, Cochrane Library, Web of Science, Sinomed, and CNKI for eligible studies evaluating the effects of obesity on the prognosis of PLC. Data on PLC-related mortality, all-cause mortality, or recurrence should be available to obtain, and studies providing regional, or sex specificity are of concern. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were used to assess the pooled risk. RESULTS Obesity is strongly associated with an increased risk for PLC-related mortality. A significant regional difference was observed (North America: HR, 1.57; 95% CI, 1.06-2.34; Europe: HR, 1.53; 95% CI, 1.08-2.16; Asia: HR, 1.05; 95% CI, 0.92-1.19; Oceania: HR, 1.13; 95% CI, 0.76-1.67). A stronger association between excess body mass index (BMI) and an increased risk for PLC-related mortality was demonstrated in men compared with women (men: HR, 1.87; 95% CI, 1.25-2.77; women: HR, 1.22; 95% CI, 1.00-1.47). No association was observed in the analysis between obesity and all-cause mortality and recurrence risk in PLC (all-cause mortality: HR, 1.01; 95% CI, 0.96-1.06; recurrence risk: HR, 1.00; 95% CI, 0.88-1.15). CONCLUSION This study demonstrated a stronger association between obesity and PLC-related mortality in North America and Europe and among men.
Collapse
Affiliation(s)
- Long-Shan Yang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Lun-Jie Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Yu-Chuan Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Zi-Niu Ding
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Hui Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Si-Yu Tan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Zhao-Ru Dong
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Dong-Xu Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Tao Li
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
| |
Collapse
|
8
|
Liu J, Luo H, Huang L, Wang J. Prevalence of sarcopenia among patients with hepatocellular carcinoma: A systematic review and meta‑analysis. Oncol Lett 2023; 26:283. [PMID: 37274463 PMCID: PMC10236145 DOI: 10.3892/ol.2023.13869] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 04/05/2023] [Indexed: 06/06/2023] Open
Abstract
Sarcopenia is a common condition in patients with hepatocellular carcinoma (HCC). Sarcopenia affects the prognosis of patients with HCC and reduces their quality of life. However, to date, there has been no systematic review and meta-analysis to assess the prevalence of sarcopenia in patients with HCC, to the best of our knowledge. PubMed, Embase, Web of Science and the Cochrane Library were comprehensively screened for relevant literature published from March 2001 to June 2022. A random effect analysis was conducted to pool the incidence rates for each study. Subgroup and meta-regression analyses were used to investigate the latent sources of heterogeneities. The Newcastle-Ottawa Scale was used to estimate the quality of the included studies. The I2 statistic was used to evaluate heterogeneity between studies. In total, 48 studies encompassing 8,959 patients were included in the meta-analysis. The results of the present meta-analysis showed that nearly half (42%) of the patients with HCC had sarcopenia (95% CI, 0.36-0.48). The morbidity of sarcopenia in studies with a high proportion of males (45%) was higher compared with the morbidity observed in studies with a lower proportion of males (37%). In addition, the incidence rate in younger patients (46%) was found to be higher compared with the incidence rate in older patients (39%). In conclusion, the findings in the present systematic review revealed that a large number of patients with HCC suffer from sarcopenia, indicating the necessity of developing screening and intervention measures to improve the outcome in these patients.
Collapse
Affiliation(s)
- Jiye Liu
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, P.R. China
- Department of Rehabilitation Medicine, Huludao Central Hospital, Huludao, Liaoning 125000, P.R. China
| | - Hanyong Luo
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, P.R. China
| | - Letian Huang
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, P.R. China
| | - Jiahe Wang
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110000, P.R. China
| |
Collapse
|
9
|
Peri V, Lee E, Fink M, Starkey G, Nikfarjam M, Yoshino O, Furtado R, Sinclair M, Testro A, Majumdar A, Jones R, Muralidharan V, Perini MV. A Single Centre Experience with Pre-Operative Markers in the Prediction of Outcomes after Liver Resection for Hepatocellular Carcinoma. J Gastrointest Surg 2023; 27:1376-1386. [PMID: 37095335 DOI: 10.1007/s11605-023-05681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/08/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM The C-reactive protein to albumin ratio, albumin-bilirubin index and platelet-albumin-bilirubin index have emerged as prognostic scores in hepatocellular carcinoma, although their clinical utility remains unclear, with ongoing investigation in multiple patient populations. This study aims to report survival outcomes and evaluate these indices in a cohort of patients undergoing liver resection for hepatocellular carcinoma in a tertiary Australian centre. METHODS This retrospective study reviewed data from the Department of Surgery at Austin Health and electronic health records (Cerner corporation). The impact of pre, intra and post-operative parameters on post-operative complications, overall and recurrence free survival were analyzed. RESULTS 163 liver resections were performed in 157 patients between 2007 and 2020. Post-operative complications occurred in 58 patients (35.6%), with pre-operative albumin < 36.5 g/L (3.41(1.41-8.29),p = 0.007) and open liver resection (3.93(1.38-11.21),p = 0.011) demonstrating independent predictive significance. 1,3 and 5-year overall survival was 91.0%, 76.7% and 66.9% respectively, with a median survival time of 92.7 months (81.3-103.9). Hepatocellular carcinoma recurred in 95 patients (58.3%) with a median time to recurrence of 27.8 months (15.6-39.9). 1,3 and 5 year recurrence-free survival rates were 94.0%, 73.7% and 55.1% respectively. Pre-operative C-reactive protein-albumin ratio > 0.034 was significantly associated with reduced overall (4.39(1.19-16.16),p = 0.026) and recurrence-free (2.53(1.21-5.30),p = 0.014) survival. CONCLUSION C-reactive protein-albumin ratio > 0.034 is a strong predictor of poor prognosis following liver resection for hepatocellular carcinoma. In addition, pre-operative hypoalbuminemia was associated with post-operative complications, and future studies are required to assess the potential benefits of albumin replacement in reducing post-surgical morbidity.
Collapse
Affiliation(s)
- Varun Peri
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
| | - Eunice Lee
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Michael Fink
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Graham Starkey
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Osamu Yoshino
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Ruelan Furtado
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Marie Sinclair
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Avik Majumdar
- Victorian Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Robert Jones
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Vijayaragavan Muralidharan
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia
| | - Marcos Vinicius Perini
- Department of Surgery (Austin Precinct), LVL 8, LTB, Austin Hospital, The University of Melbourne, 145 Studley Road, Heidelberg, 3084, Australia.
- HPB & Liver Transplant Unit, 145 Studley Road, Austin HealthHeidelberg, 3084, Australia.
| |
Collapse
|
10
|
Oura K, Morishita A, Manabe T, Takuma K, Nakahara M, Tadokoro T, Fujita K, Mimura S, Tani J, Ono M, Ogawa C, Moriya A, Senoo T, Tsutsui A, Nagano T, Takaguchi K, Himoto T, Masaki T. Relationship between Accurate Diagnosis of Sarcopenia and Prognosis in Patients with Hepatocellular Carcinoma Treated with Atezolizumab plus Bevacizumab Combination Therapy. Cancers (Basel) 2023; 15:3243. [PMID: 37370853 DOI: 10.3390/cancers15123243] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Although there have been advances in the prevention and diagnosis of hepatocellular carcinoma (HCC) in recent years, many HCC patients are still diagnosed with advanced stage. Systemic therapy is indicated for unresectable HCC (uHCC) with major vascular invasion and/or extrahepatic metastases, and the atezolizumab plus bevacizumab (atezo/bev) combination is currently recommended as first-line treatment for uHCC. Recently, sarcopenia-related factors, including decreased skeletal muscle index (SMI), have been reportedly associated with prognosis in uHCC patients treated with sorafenib or lenvatinib. There are few reports on muscle strength assessments, including grip strength (GS), despite their importance in accurate sarcopenia diagnosis, and furthermore, there is no evidence regarding atezo/bev therapy. In this study, we investigated whether sarcopenia affects the clinical outcome of atezo/bev therapy. This study included 64 uHCC patients on atezo/bev therapy and assessed their GS and SMI, and SMI was measured using bioelectrical impedance analysis (BIA). We diagnosed sarcopenia based on GS and BIA-SMI and compared the clinical outcomes in the sarcopenia and non-sarcopenia groups. Of these patients, 28 had sarcopenia, and 36 had non-sarcopenia. Adverse events (AEs) frequently occurred, and the albumin-bilirubin score significantly decreased after atezo/bev therapy in the sarcopenia group than in the non-sarcopenia group. The median progression-free survival was 4.7 (0.4-26.4) and 10.6 (1.1-24.5) months in the sarcopenia and non-sarcopenia groups, respectively. The median overall survival (OS) was 12.6 (1.4-27.7) months in the sarcopenia group and was not reached in the non-sarcopenia group, indicating a significant difference in the Kaplan-Meier survival curves for both groups (p < 0.01). In multivariate analysis, sarcopenia was significantly associated with OS. In conclusion, sarcopenia was significantly associated with poor clinical outcomes based on the occurrence of AEs and decreased liver function in uHCC patients on atezo/bev therapy. GS and SMI are important parameters for accurately diagnosing sarcopenia.
Collapse
Affiliation(s)
- Kyoko Oura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Takushi Manabe
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Kagawa, Japan
| | - Kei Takuma
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Mai Nakahara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Tomoko Tadokoro
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Koji Fujita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Shima Mimura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Joji Tani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Masafumi Ono
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Kagawa, Japan
| | - Akio Moriya
- Department of Gastroenterology, Mitoyo General Hospital, Kanonji 769-1695, Kagawa, Japan
| | - Tomonori Senoo
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
| | - Akemi Tsutsui
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
| | - Takuya Nagano
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
| | - Koichi Takaguchi
- Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Kagawa, Japan
| | - Takashi Himoto
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Takamatsu 761-0123, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Kagawa, Japan
| |
Collapse
|
11
|
Kuo MH, Tseng CW, Hsu CS, Chen YC, Kao IT, Wu CY, Shao SC. Prevalence and Effect of Low Skeletal Muscle Mass among Hepatocellular Carcinoma Patients Undergoing Systemic Therapy: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15092426. [PMID: 37173893 PMCID: PMC10177136 DOI: 10.3390/cancers15092426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Low skeletal muscle mass (LSMM) is associated with poor outcomes in hepatocellular carcinoma (HCC) patients. With the emergence of new systemic therapeutics, understanding the effect of LSMM on HCC treatment outcomes is critically important. This systematic review and meta-analysis investigates the prevalence and effect of LSMM among HCC patients undergoing systemic therapy as reported in studies identified in searches of the PubMed and Embase databases published through 5 April 2023. The included studies (n = 20; 2377 HCC patients undergoing systemic therapy) reported the prevalence of LSMM assessed by computer tomography (CT) and compared the survival outcomes [overall survival (OS) or progression-free survival (PFS)] between HCC patients with and without LSMM. The pooled prevalence of LSMM was 43.4% (95% CI, 37.0-50.0%). A random-effects meta-analysis showed that HCC patients receiving systemic therapy with comorbid LSMM had a lower OS (HR, 1.70; 95% CI, 1.46-1.97) and PFS (HR, 1.32; 95% CI, 1.16-1.51) than did those without. Subgroup analysis according to systemic therapy type (sorafenib, lenvatinib, or immunotherapy) yielded similar results. In conclusion, LSMM is prevalent among HCC patients undergoing systemic therapy and is associated with poorer survival. Early intervention or prevention strategies to improve muscle mass may be necessary for this patient population.
Collapse
Affiliation(s)
- Meng-Hsuan Kuo
- Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan
| | - Chih-Wei Tseng
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan
| | - Ching-Sheng Hsu
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Yen-Chun Chen
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan
| | - I-Ting Kao
- Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan
| | - Chen-Yi Wu
- Department of Pharmacy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 62247, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| |
Collapse
|
12
|
Oura K, Morishita A, Tani J, Nomura T, Manabe T, Takuma K, Nakahara M, Tadokoro T, Fujita K, Mimura S, Sanomura T, Nishiyama Y, Masaki T. Prognostic Value of Skeletal Muscle Loss in Patients with Hepatocellular Carcinoma Treated with Hepatic Arterial Infusion Chemotherapy. Cancers (Basel) 2023; 15:cancers15061834. [PMID: 36980720 PMCID: PMC10047018 DOI: 10.3390/cancers15061834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Sarcopenia-related factors, including the skeletal muscle index (SMI), are reportedly associated with prognosis in patients with hepatocellular carcinoma (HCC) receiving various treatments. However, there is no evidence relating to hepatic arterial infusion chemotherapy (HAIC). In this study, we investigated whether a low SMI was associated with worse clinical outcomes of HAIC. Seventy patients with advanced HCC were included. Clinical outcomes were compared between the decreased SMI (n = 27) and non-decreased SMI (n = 43) groups, which were classified according to changes in the SMI after 3 weeks of treatment. In the prognostic analysis, patients in the decreased SMI group had significantly shorter progression-free and overall survival (OS) than those in the non-decreased SMI group. In addition, poor nutritional status and liver function were associated with an immediate decrease in the SMI after HAIC. The therapeutic effect was worse in the decreased SMI group than in the non-decreased SMI group, although the incidence of adverse events did not significantly differ. In multivariate analysis, a decreased SMI at 3 weeks after HAIC was identified as a significant independent factor associated with OS. A decreased SMI in patients with advanced HCC undergoing HAIC was associated with poor prognosis. It is effective to monitor the SMI to evaluate general conditions and predict clinical outcomes.
Collapse
Affiliation(s)
- Kyoko Oura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Joji Tani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Takako Nomura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
- Department of Internal Medicine, HITO Medical Center, Shikokuchuo 799-0121, Japan
| | - Takushi Manabe
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu 760-0017, Kagawa, Japan
| | - Kei Takuma
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Mai Nakahara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Tomoko Tadokoro
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Koji Fujita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Shima Mimura
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| | - Takayuki Sanomura
- Department of Radiology, Kagawa University, Kita-gun 761-0793, Japan
| | | | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita-gun 761-0793, Japan
| |
Collapse
|
13
|
Guo Y, Ren Y, Zhu L, Yang L, Zheng C. Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: an updated meta-analysis. Sci Rep 2023; 13:934. [PMID: 36650190 PMCID: PMC9845331 DOI: 10.1038/s41598-022-27238-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Although numerous studies have reported the association between sarcopenia and the prognosis of hepatocellular carcinoma (HCC) patients, there is lack of a newer and more comprehensive meta-analysis. Herein, a comprehensive literature search was performed on PubMed, Web of Science, the Cochrane Library, and Embase databases to identify relevant studies published up to February 2022. The outcomes were overall survival (OS), recurrence, progression-free survival, tumor response, severe postoperative complications, and toxicity of drugs. A total of 57 studies involving 9790 HCC patients were included in the meta-analysis. The pooled prevalence of sarcopenia in HCC patients was 41.7% (95% CI 36.2-47.2%). Results demonstrated that sarcopenia was significantly associated with impaired OS (HR: 1.93, 95% CI 1.73-2.17, P < 0.001), higher risk of tumor recurrence (HR: 1.75, 95% CI 1.56-1.96, P < 0.001), lower objective response rate (OR: 0.37 95% CI 0.17-0.81, P = 0.012), and more drug-related adverse events (OR: 2.23, 95% CI 1.17-4.28, P = 0.015) in HCC patients. The subgroup analyses revealed that the OS of patients at the early stage of tumor was more severely affected by sarcopenia than for patients at other stages. Moreover, the presence of cirrhosis and Child Pugh class B increased the hazard of mortality from sarcopenia. This study has shown that sarcopenia is highly associated with poor prognosis in HCC patients. In addition, cirrhosis and poor liver functional reserve increase the danger of sarcopenia. OS was more impaired in HCC patients with sarcopenia at early stage of tumor than at other tumor stages.
Collapse
Affiliation(s)
- Yusheng Guo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yanqiao Ren
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Licheng Zhu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China. .,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China. .,Hubei Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| |
Collapse
|
14
|
Jiang C, Wang Y, Fu W, Zhang G, Feng X, Wang X, Wang F, Zhang L, Deng Y. Association between sarcopenia and prognosis of hepatocellular carcinoma: A systematic review and meta-analysis. Front Nutr 2022; 9:978110. [PMID: 36590214 PMCID: PMC9794869 DOI: 10.3389/fnut.2022.978110] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background Sarcopenia, characterized by the loss of muscle mass, strength, and physical ability, occurs with aging and certain chronic illnesses such as chronic liver diseases and cancer. Sarcopenia is common in liver cirrhosis and hepatocellular carcinoma (HCC). Previous reports of association between sarcopenia and prognosis of HCC have been inconsistent. Therefore, the present systematic review and meta-analysis aimed to investigate the impact of sarcopenia on the survival of patients with HCC. Methods A systematic literature search was conducted using PubMed, EMBASE, and Web of Science electronic databases from inception to May 1, 2022. We included retrospective or prospective studies investigating the association between sarcopenia and overall survival (OS) and/or progression free survival (PFS) of HCC. We applied the Quality in Prognosis Studies (QUIPS) instrument to evaluate the risk of bias and quality of included studies. The primary and secondary outcomes were the associations of sarcopenia with OS and PFS, respectively, expressed by a pooled hazard ratio (HR) and corresponding 95% confidence interval (CI). Subgroup analysis and sensitivity analysis were performed. We further evaluated the publication bias by the funnel plot and Begg's test. Results A total of 42 studies comprising 8,445 patients were included. The majority of included studies were at an overall low risk of bias. The pooled prevalence of sarcopenia was 39% (95% CI: 33-45%) (n = 8,203). Sarcopenia was associated with an increased risk of shorter OS, with a pooled adjusted HR of 1.84 (95% CI: 1.62-2.09). An independent association between sarcopenia and reduced PFS was observed (HR = 1.33, 95% CI: 1.12-1.56). Conclusion The prevalence of sarcopenia was approximately 39% among patients with HCC. Sarcopenia was independently associated with reduced OS and PFS in HCC irrespective of treatment modalities. It is imperative that interventions aimed at alleviating sarcopenia and restoring muscle mass be implemented in order to improve the survival of patients with HCC. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337797], identifier [CRD42022337797].
Collapse
Affiliation(s)
- Chuan Jiang
- Department of Anoenterology, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, China
| | - Yanyan Wang
- Health Management Center, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Fu
- Health Management Center, Qilu Hospital of Shandong University, Jinan, China
| | - Guozhuan Zhang
- Department of Pain Management, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaoshan Feng
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xing Wang
- College of Clinical and Basic Medical Sciences, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fang Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Le Zhang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China,Le Zhang,
| | - Yang Deng
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China,*Correspondence: Yang Deng,
| |
Collapse
|
15
|
Radu P, Ebadi M, Montano-Loza AJ, Dufour JF. What Is the Role of Body Composition Assessment in HCC Management? Cancers (Basel) 2022; 14:5290. [PMID: 36358709 PMCID: PMC9656561 DOI: 10.3390/cancers14215290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 10/06/2023] Open
Abstract
In the last decade, body composition (BC) assessment has emerged as an innovative tool that can offer valuable data concerning nutritional status in addition to the information provided by the classical parameters (i.e., body mass index, albumin). Furthermore, published data have revealed that different types of body composition are associated with different outcomes. For example, abnormalities of skeletal muscle, a common finding in cirrhotic and oncologic patients, are associated with poor outcome (i.e., high morbidity and high mortality). The disposition (visceral/subcutaneous adipose tissue) and radiodensity of adipose tissue proved to also be determinant factors for HCC outcome. Despite all the advantages, BC assessment is not part of the standard pre-therapeutic workup. The main reasons are the high heterogeneity of data, the paucity of prospective studies, the lack of a standard assessment method, and the interpopulation variation of BC. This paper aims to review the available evidence regarding the role of BC as a prognostic tool in the HCC population undergoing various therapies.
Collapse
Affiliation(s)
- Pompilia Radu
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3008 Bern, Switzerland
| | - Maryam Ebadi
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB T6G 2X8, Canada
| | - Aldo J. Montano-Loza
- Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB T6G 2X8, Canada
| | - Jean Francois Dufour
- Department for BioMedical Research, Visceral Surgery and Medicine, University of Bern, 3008 Bern, Switzerland
| |
Collapse
|
16
|
van Dijk AM, Coppens BJP, van Beers MA, Bruins Slot AS, Verstraete CJR, de Bruijne J, Vleggaar FP, van Erpecum KJ. Nutritional status in patients with hepatocellular carcinoma: Potential relevance for clinical outcome. Eur J Intern Med 2022; 104:80-88. [PMID: 35902333 DOI: 10.1016/j.ejim.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Impaired nutritional status is a risk factor for unfavorable outcome in cirrhosis. METHODS In this prospective cohort study in hepatocellular carcinoma patients referred for tumor-specific therapy, nutritional status was assessed before and 3 months post-treatment using 4 complementary tools: hand-grip strength (HGS), Liver Frailty Index (LFI), Patient-Generated Subjective Global Assessment (PG-SGA) and skeletal muscle index (L3-SMI). Uni- and multivariable analyses were performed using Kaplan Meier curves and Cox's regression analyses with correction for Barcelona Clinic Liver Cancer (BCLC) stage, alpha-fetoprotein and age. RESULTS 56 patients were evaluated at baseline and 38 patients 3 months post-treatment. Baseline BCLC stage was 0 in 14%, A in 27%, B in 36%, C in 21%, and D in 2%. HGS, LFI, PG-SGA and L3-SMI were impaired in 13%, 95%, 21% and 71% respectively. Of all patients, 52% died after (median, range) 373 (32-962) days. Of the nutritional assessment tools, only HGS was independently associated with complication-free survival (HR 0.304, 95%CI 0.10-0.88: p = 0.028) and, approaching significance, with overall survival (HR 0.323, 95%CI 0.103-1.008: p = 0.052). Tumor-specific therapy was administered in 50 patients (20% radiofrequency / microwave ablation, 4% resection, 74% transarterial radio- or chemoembolization, 2% sorafenib). Three months post-treatment, complete response occurred in 44%, partial response in 20%, stable disease in 20% and progressive disease in 16%. Child-Pugh scores deteriorated and such deterioration was independently associated with reduced overall and complication-free survival. CONCLUSIONS reduced baseline HGS and deteriorated post-treatment Child-Pugh score are associated with reduced overall and complication-free survival in HCC.
Collapse
Affiliation(s)
- Anne M van Dijk
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart J P Coppens
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Maartje A van Beers
- Department of Head and Neck Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexandra S Bruins Slot
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Carina J R Verstraete
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Frank P Vleggaar
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands.
| |
Collapse
|
17
|
Guarino M, Cossiga V, Becchetti C, Invernizzi F, Lapenna L, Lavezzo B, Lenci I, Merli M, Pasulo L, Zanetto A, Burra P, Morisco F. Sarcopenia in chronic advanced liver diseases: A sex-oriented analysis of the literature. Dig Liver Dis 2022; 54:997-1006. [PMID: 34789397 DOI: 10.1016/j.dld.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
Sarcopenia, defined as progressive and generalized loss of muscle mass and strength, is common in chronic liver disease. It significantly impacts the quality of life and increases the risk of liver-related complications and mortality in cirrhotic patients. Moreover, recent studies showed a negative impact of sarcopenia on patients awaiting liver transplantation (LT), on post-LT outcomes, and on response to hepatocellular carcinoma therapies. Data about the influence of sex on the incidence, prevalence, diagnosis and treatment of sarcopenia in chronic liver diseases are poor and conflicting. The aims of this review of the literature are to define sex differences in sarcopenic cirrhotic patients and to highlight the necessity of a sex stratified analysis in future studies. This analysis of the literature showed that most of the studies are retrospective, with a higher prevalence of sarcopenia in males, probably due to anatomical differences between the sexes. Moreover, diagnostic criteria for sarcopenia are different between studies, as there is not a defined cut-off and, as a consequence, no comparable results. In conclusion, sex seems to have an impact on sarcopenia, and future studies must accurately investigate its role in identifying and treating high-risk patients, reducing the negative impact of sarcopenia on the survival and quality of life of cirrhotic patients.
Collapse
Affiliation(s)
- Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy
| | - Valentina Cossiga
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy.
| | - Chiara Becchetti
- Hepatology, Department of Biomedical Research, University of Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland; Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Bruna Lavezzo
- Anesthesia and Intensive Care Unit 2, Liver Transplant Center, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Ilaria Lenci
- Department of Surgery Science, Hepatology and Liver Transplant Unit, Tor Vergata University, Rome, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Luisa Pasulo
- Department of Clinical Medicine, Gastroenterology-Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli Federico II", Via S. Pansini, 5, Napoli 80131, Italy
| | | |
Collapse
|
18
|
Xiao LS, Li RN, Cui H, Hong C, Huang CY, Li QM, Hu CY, Dong ZY, Zhu HB, Liu L. Use of computed tomography-derived body composition to determine the prognosis of patients with primary liver cancer treated with immune checkpoint inhibitors: a retrospective cohort study. BMC Cancer 2022; 22:737. [PMID: 35794525 PMCID: PMC9258103 DOI: 10.1186/s12885-022-09823-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) have been used to successfully treat primary liver cancer (PLC); however, identifying modifiable patient factors associated with therapeutic benefits is challenging. Obesity is known to be associated with increased survival after ICI treatment; however, the relationship between body composition (muscle, fat) and outcomes is unclear. This study aimed to evaluate the association between sarcopenia and CT-derived fat content and the prognosis of ICIs for the treatment of PLC. Methods In this retrospective cohort study of 172 patients with PLC, we measured the skeletal muscle index (SMI), skeletal muscle density, visceral adipose tissue index, subcutaneous adipose tissue index, total adipose tissue index (TATI), and visceral-to-subcutaneous adipose tissue area ratio using CT. In addition, we analyzed the impact of body composition on the prognosis of the patients. Multivariate Cox regression analysis was used to screen for influencing factors. Results Among the seven body composition components, low SMI (sarcopenia) and low TATI were significantly associated with poor clinical outcomes. Multivariate analysis revealed that sarcopenia (hazard ratio [HR], 5.39; 95% confidence interval [CI], 1.74–16.74; p = 0.004) was a significant predictor of overall survival (OS). Kaplan–Meier curves showed that sarcopenia and TATI were significant predictors of OS. Body mass index was not associated with survival outcomes. Conclusions Sarcopenia and fat tissue content appear to be independently associated with reduced survival rates in patients with PLC treated with ICIs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09823-7.
Collapse
|
19
|
Swetha M, Keerthana CK, Rayginia TP, Nath LR, Haritha NH, Shabna A, Kalimuthu K, Thangarasu AK, Aiswarya SU, Jannet S, Pillai S, Harikumar KB, Sundaram S, Anto NP, Wu DH, Lankalapalli RS, Towner R, Isakov N, Deepa SS, Anto RJ. Augmented Efficacy of Uttroside B over Sorafenib in a Murine Model of Human Hepatocellular Carcinoma. Pharmaceuticals (Basel) 2022; 15:ph15050636. [PMID: 35631464 PMCID: PMC9143354 DOI: 10.3390/ph15050636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/21/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022] Open
Abstract
We previously reported the remarkable potency of uttroside B (Utt-B), saponin-isolated and characterized in our lab from Solanum nigrum Linn, against HCC. Recently, the U.S. FDA approved Utt-B as an ‘orphan drug’ against HCC. The current study validates the superior anti-HCC efficacy of Utt-B over sorafenib, the first-line treatment option against HCC. The therapeutic efficacies of Utt-B vs. sorafenib against HCC were compared in vitro, using various liver cancer cell lines and in vivo, utilizing NOD.CB17-Prkdcscid/J mice bearing human HCC xenografts. Our data indicate that Utt-B holds an augmented anti-HCC efficacy over sorafenib. Our previous report demonstrated the pharmacological safety of Utt-B in Chang Liver, the normal immortalized hepatocytes, and in the acute and chronic toxicity murine models even at elevated Utt-B concentrations. Here, we show that higher concentrations of sorafenib induce severe toxicity, in Chang Liver, as well as in acute and chronic in vivo models, indicating that, apart from the superior therapeutic benefit over sorafenib, Utt-B is a pharmacologically safer molecule, and the drug-induced undesirable effects can, thus, be substantially alleviated in the context of HCC chemotherapy. Clinical studies in HCC patients utilizing Utt-B, is a contiguous key step to promote this drug to the clinic.
Collapse
Affiliation(s)
- Mundanattu Swetha
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
- Department of Biotechnology, University of Kerala, Thiruvananthapuram 695011, Kerala, India
| | - Chenicheri K. Keerthana
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
- Department of Biotechnology, University of Kerala, Thiruvananthapuram 695011, Kerala, India
| | - Tennyson P. Rayginia
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
- Department of Biotechnology, University of Kerala, Thiruvananthapuram 695011, Kerala, India
| | - Lekshmi R. Nath
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
- Department of Pharmacognosy, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Science Campus, Kochi 682041, Kerala, India
| | - Nair Hariprasad Haritha
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
| | - Anwar Shabna
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
| | - Kalishwaralal Kalimuthu
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
| | - Arun K. Thangarasu
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram 695019, Kerala, India; (A.K.T.); (R.S.L.)
| | - Sreekumar U. Aiswarya
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
| | - Somaraj Jannet
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
| | - Sreekumar Pillai
- Department of Surgical Oncology, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India;
| | - Kuzhuvelil B. Harikumar
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
| | - Sankar Sundaram
- Department of Pathology, Government Medical College, Kottayam 686008, Kerala, India;
| | - Nikhil Ponnoor Anto
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva 84105, Israel; (N.P.A.); (N.I.)
| | - Dee H. Wu
- Section of Medical Physics, Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- School of Computer Science, Gallogly College of Engineering, University of Oklahoma, Norman, OK 731019, USA
- School of Electrical and Computer Engineering, Gallogly College of Engineering, University of Oklahoma, Norman, OK 731019, USA
| | - Ravi S. Lankalapalli
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram 695019, Kerala, India; (A.K.T.); (R.S.L.)
| | - Rheal Towner
- Departments of Pathology and Pharmaceutical Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Noah Isakov
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva 84105, Israel; (N.P.A.); (N.I.)
| | - Sathyaseelan S. Deepa
- Department of Biochemistry and Molecular Biology, and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Ruby John Anto
- Division of Cancer Research, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram 695014, Kerala, India; (M.S.); (C.K.K.); (T.P.R.); (L.R.N.); (N.H.H.); (A.S.); (K.K.); (S.U.A.); (S.J.); (K.B.H.)
- Correspondence: ; Tel.: +91-471-2529473; Fax: +91-471-2348096
| |
Collapse
|
20
|
Dong D, Shi JY, Shang X, Liu B, Xu WL, Cui GZ, Wang NY. Prognostic significance of sarcopenia in patients with hepatocellular carcinoma treated with lenvatinib: A retrospective analysis. Medicine (Baltimore) 2022; 101:e28680. [PMID: 35119010 PMCID: PMC8812594 DOI: 10.1097/md.0000000000028680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023] Open
Abstract
Our study investigated the correlation between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma (HCC) treated with lenvatinib. We retrospectively evaluated 40 consecutive patients with unresectable HCC receiving lenvatinib between November 2018 and May 2020 at the First Hospital of Jilin University. Skeletal muscle mass was measured before treatment initiation. Prognostic significance was assessed with univariate and multivariate Cox proportional hazards models. Overall survival (OS) and progression-free survival (PFS) were evaluated for patients with and without sarcopenia. Sarcopenia was present in 23/40 patients (57.5%). After a median follow-up of 9.2 months, patients with sarcopenia had significantly worse OS and PFS compared with those without sarcopenia (OS: 8.4 months [m] vs 14.7 m, P = .02; PFS: 4.2 m vs 9.0 m, P = .04). Multivariate Cox proportional hazards models identified presence of sarcopenia as an independent risk factor for shorter OS (hazard ratio [HR], 0.257; 95% confidence interval [CI], 0.083-0.794; P = .02). In subgroup analysis, sarcopenia was associated with worse survival than non-sarcopenic patients, irrespective of age, Barcelona clinic liver cancer stage, or albumin-bilirubin grade. Our results show sarcopenia may be a predictor of poor prognosis in patients with HCC receiving lenvatinib. Management of sarcopenia is a vital factor for improving survival outcomes in patients with HCC.
Collapse
Affiliation(s)
- Dong Dong
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Jin-Yu Shi
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Xiao Shang
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Bo Liu
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Wei-Ling Xu
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Guo-Zhen Cui
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Nan-Ya Wang
- Cancer Center, First Hospital of Jilin University, Changchun, China
| |
Collapse
|
21
|
Li Q, Zhang L, Hou ZH, Zhao DX, Li JB, Zhang S, Yin Y, Ni CF, Chen T. High Visceral Adipose Tissue Density Correlates With Unfavorable Outcomes in Patients With Intermediate-Stage Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Front Cell Dev Biol 2021; 9:710104. [PMID: 34568324 PMCID: PMC8455878 DOI: 10.3389/fcell.2021.710104] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives: This study aimed to evaluate the association between different body composition features with prognostic outcomes of intermediate stage hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE). Methods: The areas and density of skeletal muscle area (SM) and adipose tissue [subcutaneous (SAT); visceral (VAT)] were calculated on the pre-TACE CT scans. Overall survival (OS) and progression-free survival (PFS) curves were calculated using the Kaplan-Meier method and compared with log-rank test. The discrimination and performance of body composition features were measured by area under time-dependent receiver operating characteristic (ROC) curve. Univariate and multivariate Cox proportional hazard analyses were applied to identify the association between body composition parameters and outcomes. Results: A significant prolonged OS and PFS was displayed by Kaplan-Meier curve analysis for HCC patients with VAT HU below -89.1 (25.1 months, 95% CI: 18.1-32.1 vs. 17.6 months, 95% CI: 16.3-18.8, p < 0.0001, 15.4 months, 95% CI: 10.6-20.2 vs. 6.6 months, 95% CI: 4.9-8.3, p < 0.0001, respectively). The 1-, 2-, 3-, and 5-year OS area under the curve (AUC) values of the VAT HU were higher than the other body composition parameters. Meanwhile, it is also found that 3-, 6-, 9-, and 12-month PFS AUC values of VAT HU were the highest among all the parameters. Univariate and multivariate Cox-regression analysis suggested a significant association between VAT density and outcomes (OS, HR: 1.015, 95% CI: 1.004-1.025, p = 0.005, PFS, HR: 1.026, 95% CI: 1.016-1.036, p < 0.0001, respectively). Conclusion: The VAT density could provide prognostic prediction value and may be helpful to stratify the intermediate stage HCC patients.
Collapse
Affiliation(s)
- Qiang Li
- Department of Radiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Lei Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong-Heng Hou
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong-Xu Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian-Bin Li
- Department of Radiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Shuai Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cai-Fang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Chen
- Department of General Surgery, Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| |
Collapse
|
22
|
Takahashi S. Fatigue and its management in cancer patients undergoing VEGFR-TKI therapy. Expert Opin Drug Saf 2021; 21:397-406. [PMID: 34461788 DOI: 10.1080/14740338.2021.1969360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Fatigue is the most common side effect of cancer and cancer treatment and is often called cancer fatigue or cancer-related fatigue. For cancer patients, cancer-related fatigue has a negative impact on participation in work and social activities, mood, and daily activities, significantly impairing quality of life. Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) sometimes cause fatigue, and early detection and appropriate management of fatigue in cancer patients treated with a VEGFR-TKI prevent fatigue from becoming more severe, thus maximizing the benefits of the treatment. AREAS COVERED This paper focuses on fatigue and discusses its frequency, assessment, risk factors, and management methods. EXPERT OPINION The drugs currently available for treating cancer-related fatigue are not effective enough, and their mechanisms of action are not fully understood. Some agents have demonstrated efficacy as treatments for fatigue due to pharmacotherapy, and further elucidation of their mechanisms is expected, together with the development of new drugs. Since fatigue has a range of causes, its treatment requires not only medication, but also exercise, nutrition, and other therapeutic approaches. The successful treatment of fatigue will therefore need multidisciplinary therapy involving the establishment of systems of cooperation across various specialties.
Collapse
Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
23
|
Rinninella E, Cintoni M, Raoul P, Ponziani FR, Pompili M, Pozzo C, Strippoli A, Bria E, Tortora G, Gasbarrini A, Mele MC. Prognostic value of skeletal muscle mass during tyrosine kinase inhibitor (TKI) therapy in cancer patients: a systematic review and meta-analysis. Intern Emerg Med 2021; 16:1341-1356. [PMID: 33337518 PMCID: PMC8310498 DOI: 10.1007/s11739-020-02589-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
Low muscle mass has been associated with worse clinical outcomes in various cancers. This work investigated whether, during tyrosine kinases inhibitors (TKIs) therapy, low muscle mass was associated with treatment toxicity and survival outcomes. A systematic literature search was performed in Pubmed, Web of Science, and Scopus databases from inception to June 2020, based on fixed inclusion and exclusion criteria. Effect sizes were estimated with hazard ratios (HR) and odds ratios (OR) with 95% confidence interval (CI) and heterogeneity was assessed by measuring inconsistency (I2) based on the Chi squared test. A total of 24 retrospective studies were identified, enrolling patients treated with sorafenib (n = 12), sunitinib (n = 6), lenvatinib (n = 3), regorafenib (n = 2), gefitinib (n = 1), imatinib (n = 1), and pazopanib (n = 1). Thirteen studies were deemed eligible for pooled analyses. Meta-analyses found a significant effect of low muscle mass on dose-limiting toxicity (DLT) (OR 2.40, 95% CI 1.26-4.58, p = 0.008, I2 = 51%) in patients treated with TKI therapy. A subgroup analysis by treatment showed an association between DLT and low muscle during sorafenib or sunitinib, although not significant. A significant association between low skeletal muscle index and poorer overall survival was observed in HCC patients treated with sorafenib (HR 1.45, 95% CI 1.07-1.96, p = 0.02). For other TKIs, although some results showed an association between low muscle mass and worse outcomes, the number of studies for each TKI therapy was too small to reach conclusions. Skeletal muscle mass could influence the prognosis of some TKI-treated patients. This effect is demonstrated in sorafenib-treated HCC patients but remains almost unexplored in other cancer patients undergoing TKI therapy. Further prospective studies with large sample size and sufficient follow-up are needed to clarify the role of muscle mass in the metabolism of TKI-based cancer treatment, and its association with toxicity and survival.
Collapse
Affiliation(s)
- Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza Dell'Alimentazione, Università di Roma Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Pauline Raoul
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesca Romana Ponziani
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maurizio Pompili
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Carmelo Pozzo
- Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Antonia Strippoli
- Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Emilio Bria
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giampaolo Tortora
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
- Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Maria Cristina Mele
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| |
Collapse
|
24
|
Sato H, Goto T, Hayashi A, Kawabata H, Okada T, Takauji S, Sasajima J, Enomoto K, Fujiya M, Oyama K, Ono Y, Sugitani A, Mizukami Y, Okumura T. Prognostic significance of skeletal muscle decrease in unresectable pancreatic cancer: Survival analysis using the Weibull exponential distribution model. Pancreatology 2021; 21:892-902. [PMID: 33722506 DOI: 10.1016/j.pan.2021.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Decrease in skeletal muscle mass and function is associated with a poor prognosis following surgical resection of pancreatic ductal adenocarcinomas (PDAs). This study evaluated whether skeletal muscle mass decrease affects PDA outcomes. METHODS Data of 112 patients with advanced and unresectable PDA who underwent chemotherapy in a single institution were retrospectively analyzed. Information on age, sex, hematological investigations, including systemic inflammation-based markers and nutritional assessment biomarkers, and imaging parameters of skeletal muscle mass and visceral adipose tissue were retrieved from the patients' medical records. The efficiency of the Cox, Weibull, and standardized exponential models were compared using hazard ratios and the Akaike Information Criterion (AIC). RESULTS Results from the Weibull, Cox, and standardized exponential model analyses indicated that low skeletal muscle mass, Eastern Cooperative Oncology Group performance status (PS), and the requirement of biliary drainage were associated with the highest risk of death, followed by carcinoembryonic antigen (CEA) levels and the presence of ascites. The AIC value from the four significant parameters was lowest for the Weibull-exponential distribution (222.3) than that of the Cox (653.7) and standardized exponential models (265.7). We developed a model for estimating the 1-year survival probability using the Weibull-exponential distribution. CONCLUSIONS Low-skeletal muscle index, PS, requirement of biliary drainage, CEA levels, and presence of ascites are independent factors for predicting poor patient survival after chemotherapy. Improved survival modeling using a parametric approach may accurately predict the outcome of patients with advanced-stage PDA.
Collapse
Affiliation(s)
- Hiroki Sato
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Takuma Goto
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Akihiro Hayashi
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Hidemasa Kawabata
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Tetsuhiro Okada
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Shuhei Takauji
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Junpei Sasajima
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Katsuro Enomoto
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Mikihiro Fujiya
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Kyohei Oyama
- Department of Cardiovascular Surgery, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo-Higashi Tokushukai Hospital, 3-1, North-33, East-14, Higashi-Ku, Sapporo, Japan
| | - Ayumu Sugitani
- Institute of Biomedical Research, Sapporo-Higashi Tokushukai Hospital, 3-1, North-33, East-14, Higashi-Ku, Sapporo, Japan
| | - Yusuke Mizukami
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan; Institute of Biomedical Research, Sapporo-Higashi Tokushukai Hospital, 3-1, North-33, East-14, Higashi-Ku, Sapporo, Japan.
| | - Toshikatsu Okumura
- Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-Higashi, Asahikawa, Japan
| |
Collapse
|
25
|
Yamaoka K, Kodama K, Hiramatsu A, Ando Y, Kosaka Y, Suehiro Y, Fujii Y, Uchikawa S, Morio K, Fujino H, Nakahara T, Murakami E, Yamauchi M, Kawaoka T, Miki D, Tsuge M, Imamura M, Takahashi S, Chayama K, Aikata H. Extracellular water to total body water ratio obtained by bioelectrical impedance analysis determines the dose intensity of lenvatinib for the treatment of patients with advanced hepatocellular carcinoma. J Gastroenterol Hepatol 2021; 36:1685-1693. [PMID: 33326154 DOI: 10.1111/jgh.15377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/29/2020] [Accepted: 12/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to identify the factors that contribute to the maintenance of relative dose intensity (RDI) of lenvatinib in hepatocellular carcinoma (HCC) patients. METHODS Thirty-two patients with advanced HCC treated with lenvatinib were enrolled. We evaluated the relationship between maintenance of RDI and various clinical data, parameters obtained by body composition measurements with bioelectrical impedance analysis (BIA) and grip strength at the start of lenvatinib treatment. RESULTS Multivariate analysis showed that only the extracellular water to total body water ratio (ECW/TBW) ≤ 0.400 at initiation of treatment was associated with RDI ≥ 50% (odds ratio, 6.94; 95% confidence interval [CI], 1.00-48.00; P = 0.049). When the RDI was compared between ECW/TBW ≤ 0.400 group and ECW/TBW > 0.400 group, the RDI was significantly higher in the ECW/TBW ≤ 0.400 group at each of 0-4W, 4-6W, and 6-8W points. The P value at each point was 0.003, 0.003, and 0.005, respectively. On the other hand, multivariate analysis showed that only the ECW/TBW ≤ 0.400 at initiation of treatment was associated with the extension of duration until reduction or withdrawal of lenvatinib (hazard ratio, 4.86; 95% CI, 1.52-15.50; P = 0.007). CONCLUSION The extracellular water to total body water ratio, a parameter of body composition measurement by BIA, was significantly associated with the maintenance of RDI and the duration until reduction or withdrawal of lenvatinib in HCC patients. In addition to standard predictors such as Child-Pugh score and modified albumin-bilirubin grade that have been used to date, ECW/TBW might be a new predictor of RDI in HCC patients treated with lenvatinib.
Collapse
Affiliation(s)
- Kenji Yamaoka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Kodama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuwa Ando
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yumi Kosaka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Suehiro
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasutoshi Fujii
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Shinsuke Uchikawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kei Morio
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hatsue Fujino
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Nakahara
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eisuke Murakami
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masami Yamauchi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Daiki Miki
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Tsuge
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michio Imamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shoichi Takahashi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan.,Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
26
|
Marasco G, Dajti E, Ravaioli F, Brocchi S, Rossini B, Alemanni LV, Peta G, Bartalena L, Golfieri R, Festi D, Colecchia A, Renzulli M. Clinical impact of sarcopenia assessment in patients with liver cirrhosis. Expert Rev Gastroenterol Hepatol 2021; 15:377-388. [PMID: 33196344 DOI: 10.1080/17474124.2021.1848542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Sarcopenia is defined as loss of skeletal muscle mass, strength, and function, and it is associated with increased morbidity and mortality in patients with chronic liver disease.Areas covered: The aim of this review is to provide a detailed report on the pathophysiological mechanisms underlying sarcopenia in cirrhotic patients, the several imaging methods available for the assessment of sarcopenia and the clinical studies evaluating the prognostic role of sarcopenia presence in cirrhotic patients.Expert opinion: Sarcopenia pathogenesis is complex and multifaceted, as chronic catabolic conditions, increased energy expenditure, reduced appetite, side effects of multiple therapies, alterations in circulating levels of hormones, low protein synthesis, presence of ascites or portosystemic shunts are all factors contributing to muscle atrophy in cirrhotic patients. Computed tomography scan is the most validated method to evaluate muscle mass and quality. Sarcopenia is associated with a higher rate waitlist mortality, hepatic encephalopathy, and lower quality of life in patients with liver cirrhosis. Future studies should make an effort to unify and validate liver disease-specific cutoffs for the definition of sarcopenia.
Collapse
Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Stefano Brocchi
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Giuliano Peta
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Laura Bartalena
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Matteo Renzulli
- Radiology Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| |
Collapse
|
27
|
von Hessen L, Roumet M, Maurer MH, Lange N, Reeves H, Dufour JF, Radu P. High subcutaneous adipose tissue density correlates negatively with survival in patients with hepatocellular carcinoma. Liver Int 2021; 41:828-836. [PMID: 33280219 DOI: 10.1111/liv.14755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/08/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Body composition parameters have been reported to add information, which can lead to tailored treatment and prognostication for oncological patients. Data for patients with hepatocellular carcinoma (HCC) are scarce. We assessed the association between different body composition parameters and overall survival (OS) in two different newly diagnosed HCC populations. METHODS The area (cm2 ) and density (Hounsfield Units [HU]) of skeletal muscle (SM) and adipose tissue (subcutaneous [SAT], visceral [VAT] and intermuscular [IMAT]) were measured on computed tomography (CT) scans at the level of the third lumbar vertebra (L3) in two cohorts of patients diagnosed in different HCC stages (Bern, Switzerland n = 187 and Newcastle, United Kingdom n = 216). Univariate and multivariate Cox regressions analyses were used to assess the crude and adjusted association of body composition parameters with OS. RESULTS By univariate analysis, in both cohorts, Bern and Newcastle, high SAT density (hazard ratio [HR]: 1.35; 1.12-1.62, P < .001 and 1.44; 1.27-1.63, P < .001, respectively) and high VAT density (HR: 1.38; 1.1-1.72, P = .005 and HR: 1.53; 1.3-1.81, P < .001, respectively) correlated negatively with survival. After model adjustment for potential baseline confounders (gender, age, diabetes, cirrhosis, MELD score, BCLC stage) in a multivariate analysis, SAT density remained associated with mortality in Bern and Newcastle (Bern: HR: 1.27; 1.04-1.57, P = .022; Newcastle: HR: 1.23; 1.03-1.48, P = .022) and VAT remained associated with mortality in Bern (HR: 1.31; 1.05-1.65, P = .019). CONCLUSIONS Based on two HCC cohorts, our data show that high SAT density correlates negatively with OS in HCC patients.
Collapse
Affiliation(s)
- Leona von Hessen
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - Marie Roumet
- Department of Clinical Research, Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | | | - Naomi Lange
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Helen Reeves
- The Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
- The Liver Unit, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jean-François Dufour
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - Pompilia Radu
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| |
Collapse
|
28
|
Federico P, Giunta EF, Pappalardo A, Tufo A, Marte G, Attademo L, Fabbrocini A, Petrillo A, Daniele B. How to Treat Hepatocellular Carcinoma in Elderly Patients. Pharmaceuticals (Basel) 2021; 14:233. [PMID: 33800217 PMCID: PMC8001824 DOI: 10.3390/ph14030233] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of "elderly" and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.
Collapse
Affiliation(s)
- Piera Federico
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Emilio Francesco Giunta
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Annalisa Pappalardo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Andrea Tufo
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Gianpaolo Marte
- Surgical Unit, Ospedale del Mare, 80147 Napoli, Italy; (A.T.); (G.M.)
| | - Laura Attademo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Antonietta Fabbrocini
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| | - Angelica Petrillo
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
- Department of Precision Medicine, School of Medicine, University of Study of Campania “L. Vanvitelli”, 80131 Napoli, Italy
| | - Bruno Daniele
- Medical Oncology Unit, Ospedale del Mare, 80147 Napoli, Italy; (E.F.G.); (A.P.); (L.A.); (A.F.); (A.P.); (B.D.)
| |
Collapse
|
29
|
Qayyum A, Bhosale P, Aslam R, Avritscher R, Ma J, Pagel MD, Sun J, Mohamed Y, Rashid A, Beretta L, Kaseb AO. Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma. Abdom Radiol (NY) 2021; 46:1008-1015. [PMID: 32974761 PMCID: PMC8191337 DOI: 10.1007/s00261-020-02751-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Sarcopenia is an independent prognostic indicator for hepatocellular carcinoma (HCC). Our objective was to determine the effect of sarcopenia on response to systemic targeted therapy in patients with advanced HCC. MATERIALS AND METHODS This was a retrospective, Institutional Review Board approved study of 36 patients on systemic targeted therapy with immune checkpoint blockade (n = 25) or tyrosine kinase inhibitor (n = 11) for biopsy-proven advanced HCC. Skeletal muscle index (SMI) was calculated from erector spinae muscle area (SMA) at the level of T12 on pretreatment CT: [SMI = SMA (cm2)/height (m2)]. SMI was compared to treatment response defined as overall survival ≥ 1 year (nonsurgical patients) or > 50% HCC necrosis (surgical patients). Receiver operating characteristic curve and area under the curve was used for analysis with p < 0.05 for statistical significance. RESULTS Median age of men and women was 66.5 years (range 32-83) and 70 years (range 54-78), respectively. Liver disease etiology was nonalcoholic steatohepatitis (n = 9), hepatitis C (n = 10), hepatitis B (n = 5), alcohol (n = 3) and unknown (n = 9). Mean (± SD) height and SMI for men were 1.7 m (± 0.1) and 11.4 (± 3.6); values for women were 1.7 m (± 0.1) and 8.2 (± 1.9). Treatment was withdrawn in five patients due to treatment intolerance. Response occurred in 10/31 (32.3%) patients (23 men, 8 women). T12SMI correlated with treatment response using a threshold of 7.21-8.23 for women (AUC = 1; p = 0.037), and 11.47 for men (AUC = 0.83; p = 0.015); correlation was increased for men ≥ 60 years, (AUC = 0.87; p = 0.023). CONCLUSION Sarcopenia was associated with reduced survival and HCC necrosis in patients treated with systemic targeted therapy. CLINICAL RELEVANCE Sarcopenia may help in predicting outcomes to targeted therapy in advanced HCC.
Collapse
Affiliation(s)
- Aliya Qayyum
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Priya Bhosale
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Rizwan Aslam
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Mark D Pagel
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Yehia Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Laura Beretta
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| |
Collapse
|
30
|
Akce M, Liu Y, Zakka K, Martini DJ, Draper A, Alese OB, Shaib WL, Wu C, Wedd JP, Sellers MT, Bilen MA, El-Rayes BF. Impact of Sarcopenia, BMI, and Inflammatory Biomarkers on Survival in Advanced Hepatocellular Carcinoma Treated With Anti-PD-1 Antibody. Am J Clin Oncol 2021; 44:74-81. [PMID: 33350681 DOI: 10.1097/coc.0000000000000787] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sarcopenia and inflammation are independently associated with worse survival in cancer patients. This study aims to determine the impact of sarcopenia, body mass index (BMI), and inflammatory biomarkers on survival in advanced hepatocellular carcinoma (HCC) patients treated with anti-PD-1 antibody-based immunotherapy. METHODS A retrospective review of advanced HCC patients treated with immunotherapy at Winship Cancer Institute between 2015 and 2019 was performed. Baseline computed tomography and magnetic resonance images were collected at mid-L3 level, assessed for skeletal muscle density using SliceOmatic (TomoVision, version 5.0) and converted to skeletal muscle index (SMI) by dividing it by height (m2). Sex-specific sarcopenia was defined by the median value of SMI. The optimal cut for continuous inflammation biomarker was determined by bias-adjusted log-rank test. Overall survival (OS) was set as primary outcome and Cox proportional hazard model was used for association with survival. RESULTS A total of 57 patients were included; 77.2% male, 52.6% Caucasian, 58.5% Eastern Cooperative Oncology Group performance status 0-1, 80.7% Child Pugh A. Treatment was second line and beyond in 71.9% of patients. The median follow-up time was 6 months. Sarcopenia cut-off for males and females was SMI of 43 and 39, respectively. 49.1% of patients had sarcopenia. Median OS was 5 versus 14.3 months in sarcopenic versus nonsarcopenic patients (Log-rank P=0.054). Median OS was 5 and 17.5 months in patients with BMI <25 and BMI ≥25, respectively (Log-rank P=0.034). Median OS was 3.6 and 14.3 months for patients with neutrophil-to-lymphocyte ratio (NLR) ≥5.15 versus NLR <5.15 (Log-rank P<0.001). In multivariable Cox regression model, higher baseline NLR was associated with worse OS (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 1.52-11.39, P=0.005). Sex-specific sarcopenia showed a trend of worse OS (HR: 1.71, 95% CI: 0.73-4.00, P=0.215) but was not statistically significant. BMI<25 was associated with worse OS (HR: 2.28, 95% CI: 0.92-5.65, P=0.076). In the association with progression free survival, neither baseline BMI nor sex-specific sarcopenia showed statistical significance. CONCLUSION After controlling for baseline Child Pugh score and NLR, sex-specific sarcopenia does not predict OS. Baseline BMI and NLR together may predict OS in advanced HCC patients treated with anti-PD-1 antibody.
Collapse
Affiliation(s)
- Mehmet Akce
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Katerina Zakka
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Dylan J Martini
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Amber Draper
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Olatunji B Alese
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Walid L Shaib
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Christina Wu
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Joel P Wedd
- Department of Medicine, Division of Digestive Diseases
| | - Marty T Sellers
- Department of Surgery, Division of Transplantation, Emory University School of Medicine
| | - Mehmet A Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Bassel F El-Rayes
- Department of Hematology and Medical Oncology, Winship Cancer Institute
| |
Collapse
|
31
|
Guan J, Yang Q, Chen C, Wang G, Zhu H. Prognostic value of low skeletal muscle mass in hepatocellular carcinoma patients treated with sorafenib or lenvatinib: A meta-analysis. EXCLI JOURNAL 2021; 20:1-16. [PMID: 33510588 PMCID: PMC7838828 DOI: 10.17179/excli2020-3111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022]
Abstract
Growing evidence indicates that skeletal muscle depletion has a notable effect on the prognosis of hepatocellular carcinoma (HCC) patients, though study results are still controversial. Our meta-analysis aimed at evaluating the prognostic significance of low skeletal muscle mass (LSMM) in HCC patients treated with sorafenib or lenvatinib.We systematically reviewed for PubMed, Cochrane, and Embase databases from their inception to August 2020 and obtained all relevant articles describing an association between LSMM and HCC patients treated with sorafenib or lenvatinib. Demographic and characteristics of included studies, diagnostic criteria of skeletal muscle depletion, and main outcomes (overall survival, progression-free survival, time to treatment failure) were retrieved. Associations were expressed by calculating hazard ratios (HRs) and 95 % confidence intervals (CIs).The meta-analysis enrolled 11 studies comprising 1148 patients. Without significant heterogeneity between studies, LSMM was significantly associated with poor overall survival (crude HR=1.58, 95 % CI: 1.36-1.83; adjusted HR=1.83, 95 % CI: 1.46-2.29) and time to treatment failure (crude HR=1.85, 95 % CI: 1.34-2.54; adjusted HR=1.72, 95 % CI: 1.24-2.38). However, there was no significantly association between LSMM and progression-free survival (adjusted HR=1.44, 95 % CI: 0.95-2.20). Symmetry of distribution on the funnel plot did not show significant publication bias.This meta-analysis supported that LSMM is significantly associated with poor overall survival and time to treatment failure in HCC patients after sorafenib or lenvatinib administration. This negative effect was pronounced even after adjustment for confounders. Future studies should be carried out on larger samples and study regions based on standardized thresholds of LSMM.
Collapse
Affiliation(s)
- Jun Guan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine
| | - Qin Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine
| | - Chao Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine
| | - Gang Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine
| | - Haihong Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine
| |
Collapse
|
32
|
Wu CH, Shao YY, Ting-Fang Shih T. Reply to letter to the editor: Low skeletal muscle mass are predictive factors of survival for advanced hepatocellular carcinoma. J Formos Med Assoc 2021; 120:781-782. [DOI: 10.1016/j.jfma.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/01/2022] Open
|
33
|
Cheng TY, Lee PC, Chen YT, Chao Y, Hou MC, Huang YH. Pre-sarcopenia determines post-progression outcomes in advanced hepatocellular carcinoma after sorafenib failure. Sci Rep 2020; 10:18375. [PMID: 33110117 PMCID: PMC7591538 DOI: 10.1038/s41598-020-75198-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
Many second-line therapies are recently approved for patients with advanced hepatocellular carcinoma (HCC), in whom protein malnutrition is prevalent that would affect treatment outcomes. In this study, we aimed to investigate the role of pre-sarcopenia and muscle restoration in patients with sorafenib-failed advanced HCC. From August 2012 to March 2017, 385 patients who developed radiology-proven HCC progression after sorafenib treatment were enrolled in the study. Pre-sarcopenia is defined as transverse psoas muscle thickness per body height < 16.8 mm/m, which was prevalent (64.7%) in our patients. Age > 60 years, female gender, and body mass index < 22 kg/m2 were independent predictors to the development of pre-sarcopenia. Patients with muscle depletion had significantly worse post-progression survival (PPS) compared with their counterparts (median PPS: 3.8 vs. 5.8 months, p = 0.003), particularly in those with intermediate liver reserves (Child–Pugh class B or Albumin-bilirubin grade 2). Besides, pre-sarcopenia independently predicted post-progression mortality in sorafenib-failed HCC (hazard ratio: 1.340, p = 0.012). In patients who developed pre-sarcopenia before sorafenib treatment, muscle restoration was associated with a longer PPS compared with their counterparts (6.3 vs. 3.6 months, p = 0.043). In conclusion, pre-sarcopenia independently determined the outcomes of sorafenib-failed HCC. Nutrition support to restore muscle mass would prolong survival for higher-risk patients.
Collapse
Affiliation(s)
- Tsung-Yi Cheng
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Tzen Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| |
Collapse
|
34
|
Skeletal Muscle Loss during Multikinase Inhibitors Therapy: Molecular Pathways, Clinical Implications, and Nutritional Challenges. Nutrients 2020; 12:nu12103101. [PMID: 33053632 PMCID: PMC7601327 DOI: 10.3390/nu12103101] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022] Open
Abstract
In cancer patients, loss of muscle mass is significantly associated with low tolerability of chemotherapy and poor survival. Despite the great strides in the treatment of cancer, targeted therapies such as tyrosine kinase inhibitors (TKIs) could exacerbate muscle wasting. Over recent years, the impact of skeletal muscle loss during TKI therapy on clinical outcomes has been in the spotlight. In this review, we focus on the different molecular pathways of TKIs potentially involved in muscle wasting. Then, we report the results of the studies assessing the effects of different TKI therapies—such as sorafenib, regorafenib, sunitinib, and lenvatinib—on muscle mass, and highlight their potential clinical implications. Finally, we discuss an integrative nutritional approach to be adopted during TKI treatment. The assessment of muscle mass from computerized tomography imaging could be helpful in predicting toxicity and prognosis in patients treated with TKI such as sorafenib. Early recognition of low muscle mass and effective personalized nutritional support could prevent or attenuate muscle mass wasting. However, the role of nutrition is still overlooked, and future clinical trials are needed to find the optimal nutritional support to countermeasure muscle mass depletion during TKI therapy.
Collapse
|
35
|
Marasco G, Serenari M, Renzulli M, Alemanni LV, Rossini B, Pettinari I, Dajti E, Ravaioli F, Golfieri R, Cescon M, Festi D, Colecchia A. Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments. J Gastroenterol 2020; 55:927-943. [PMID: 32748172 PMCID: PMC7519899 DOI: 10.1007/s00535-020-01711-w] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/15/2020] [Indexed: 02/04/2023]
Abstract
Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients' survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed.
Collapse
Affiliation(s)
- Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy.
| | - Matteo Serenari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Matteo Renzulli
- Radiology Unit, Sant'Orsola Malpighi Hospital, Via Albertoni 4, 40138, Bologna, Italy
| | - Luigina Vanessa Alemanni
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Irene Pettinari
- Radiology Unit, Sant'Orsola Malpighi Hospital, Via Albertoni 4, 40138, Bologna, Italy
| | - Elton Dajti
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Sant'Orsola Malpighi Hospital, Via Albertoni 4, 40138, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126, Bologna, Italy
| | - Antonio Colecchia
- Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
| |
Collapse
|
36
|
Oh S, Lee J. Sarcopenia and blood myokine levels as prognostic biomarkers in patients with liver cirrhosis or hepatocellular carcinoma. Clin Mol Hepatol 2020; 26:476-479. [PMID: 33053929 PMCID: PMC7641548 DOI: 10.3350/cmh.2020.0192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/28/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sooyeon Oh
- Chaum Life Center, Department of Internal Medicine, CHA University School of Medicine, Seoul, Korea
| | - Jooho Lee
- Chaum Life Center, Department of Internal Medicine, CHA University School of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
37
|
Ligibel JA, Schmitz KH, Berger NA. Sarcopenia in aging, obesity, and cancer. Transl Cancer Res 2020; 9:5760-5771. [PMID: 33163373 PMCID: PMC7643855 DOI: 10.21037/tcr-2019-eaoc-05] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022]
Abstract
Sarcopenia, defined as loss of muscle mass, strength and physical performance, is a hallmark of aging and is invariably associated with perturbation of amino acid metabolism, increased muscle protein catabolism relative to anabolism, and loss of muscle fibers. Sarcopenia may be associated with general loss of body mass, or it may also occur along with obesity [sarcopenic obesity (SO)]. Although sarcopenia is associated with multiple comorbidities in older adults, its effects may even be more severe in patients with malignant disease where it has been shown to contribute to poor surgical outcomes, increased chemotherapy toxicity associated with both cytotoxic and targeted agents, as well as adversely impacting survival. While development of sarcopenia is a common age-related phenomenon, the associated catabolic processes appear to be promoted by physical inactivity, inadequate nutrition, and systemic low-grade inflammation, as well as intrinsic muscle and molecular changes, including mitochondrial dysfunction and impaired muscle stem cell regenerative capacity. Increased physical activity and adequate protein intake can reduce incidence and severity of sarcopenia in cancer patients, but many older cancer patients do not meet physical activity and nutrition recommendations, and cancer treatment can make it more difficult to make favorable lifestyle changes. Sarcopenia is discussed in terms of its adverse clinical consequences in older subjects and particularly, in older patients with cancer. Contributions of lifestyle, molecular, and cellular factors are likewise reviewed with suggestions for interventions to improve sarcopenia and its comorbid sequalae.
Collapse
Affiliation(s)
- Jennifer A. Ligibel
- Division of Women’s Cancers, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Kathryn H. Schmitz
- Department Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Nathan A. Berger
- Department Medicine, Biochemistry, Oncology, Genetics & Genome Sciences, Center for Science, Health and Society, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
38
|
Impact of Grip Strength in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib. Cancers (Basel) 2020; 12:cancers12082146. [PMID: 32756366 PMCID: PMC7465794 DOI: 10.3390/cancers12082146] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
Although sarcopenia is characterized by a loss of muscle strength and skeletal muscle mass, few studies have evaluated the effect of muscle strength on hepatocellular carcinoma (HCC) patients. We evaluated the impact of sarcopenia-related factors (grip strength (GS) and the skeletal muscle index (SMI)) on the survival among lenvatinib-treated unresectable HCC (u-HCC) patients. This single-center cohort study was conducted at a university hospital. The study population included 63 lenvatinib-treated u-HCC patients managed between April 2018 and April 2020. A decreased GS and decreased SMI were found in 21 (33.3%) and 22 (34.9%) patients, respectively. The overall survival (OS) of the normal GS group was significantly higher than that of the decreased GS group, while that of the normal and decreased SMI groups did not differ markedly. There were no significant differences in the progression-free survival between the normal GS and decreased GS groups or the normal SMI and decreased SMI groups. A multivariate Cox proportional hazards model showed that modified albumin-bilirubin-grade (mALBI) 2b (hazard ratio (HR) 4.39) and a decreased GS (HR 3.55) were independently associated with an increased risk of poor prognosis. In addition to the hepatic functional reserve, a decreased GS was a poor prognostic factor in lenvatinib-treated u-HCC patients.
Collapse
|
39
|
Yttrium-90 radioembolization for hepatocellular carcinoma: Outcome prediction with MRI derived fat-free muscle area. Eur J Radiol 2020; 125:108889. [PMID: 32087468 DOI: 10.1016/j.ejrad.2020.108889] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/24/2020] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Sarcopenia is associated with adverse outcomes in several gastrointestinal malignancies and liver cirrhosis. We aimed to study the utility of magnetic resonance imaging (MRI) derived fat-free muscle area (FFMA) to predict clinical outcome in patients receiving yttrium-90 radioembolization (RE) for treatment of hepatocellular carcinoma (HCC). METHODS Fifty-eight patients with unresectable HCC and pre-interventional liver MRI undergoing salvage RE were retrospectively evaluated. Using axial T2-weighted turbo spin echo sequences, FFMA was calculated by subtraction of the intramuscular adipose tissue area from the total cross-sectional area of paraspinal skeletal muscles at the superior mesenteric artery level. FFMA values lower than 3582 mm2 in male and 2301 mm2 in female patients were defined as low FFMA. Main outcomes were progression-free survival (PFS) and overall survival (OS). For outcome analysis, the Kaplan-Meier method with log rank test and multivariate cox regression analysis were used. RESULTS Mean time from pre-interventional MRI to RE was 27 ± 20 days. Median OS and PFS after RE were 250 (range: 21-1230 days) and 156 days (range: 21-674 days), respectively. Patients with low FFMA showed significantly reduced OS (197 vs. 294 days, P = 0.024) and tended to have shortened PFS (109 vs. 185 days, P = 0.068). Low FFMA (HR 2.675; P = 0.011), estimated liver tumor burden (HR 4.058; P = 0.001), and Eastern Cooperative Oncology Group (ECOG) performance status (1.763; P = 0.009) were independent predictors of OS on multivariate analysis. CONCLUSIONS FFMA as a measure of sarcopenia predicts OS and might represent a promising new biomarker for survival prognosis in patients undergoing RE for treatment of unresectable HCC.
Collapse
|
40
|
Salman MA, Omar HSE, Mikhail HMS, Tourky M, El-Ghobary M, Elkassar H, Omar MG, Matter M, Elbasiouny AM, Farag AM, Shaaban HED, Atallah M, Elshabacy O, Salman AA. Sarcopenia increases 1-year mortality after surgical resection of hepatocellular carcinoma. ANZ J Surg 2020; 90:781-785. [PMID: 31943655 DOI: 10.1111/ans.15647] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/23/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Liver resection is a well-recognized modality for hepatocellular carcinoma. Cirrhotic patients are more prone to adverse consequences after liver resection. This work assesses the prognostic significance of sarcopenic hepatocellular carcinoma cases for whom surgical resection was performed. METHODS The present prospective work included 52 cirrhotic cases. Computed tomography scans were used to determine the skeletal muscle index (SMI) at the plane of the third lumbar vertebra (L3). L3 SMI was used for the definition of sarcopenia. The primary outcome measure was the predictive value of sarcopenia for 1-year post-hepatectomy mortality. RESULTS Sarcopenia was diagnosed in 27 patients (51.9%). All patients had a Child-Turcotte-Pugh score A. At a 1-year follow-up, 20 cases died; that is the 1-year mortality rate was 38.5%. Sarcopenia was more commonly associated with older age and non-viral causes of cirrhosis. The risk of 1-year mortality is 7.6 times higher in sarcopenic patients with a risk ratio of 3.7 (95% confidence interval 1.4-9.6). CONCLUSION Sarcopenia diagnosed using L3 SMI is an independent prognostic factor for 1-year deaths in cases with hepatic malignancy with Child-Turcotte-Pugh score A undergoing surgical resection.
Collapse
Affiliation(s)
- Mohamed A Salman
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Haitham S E Omar
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hani M S Mikhail
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Tourky
- General Surgery Department, Alawi Tunsi Hospital, Mecca, Saudi Arabia
| | - Mohamed El-Ghobary
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Elkassar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud G Omar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Matter
- Radiodiagnosis Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Ahmed M Elbasiouny
- Radiodiagnosis Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Ayman M Farag
- Radiodiagnosis Department, Military Medical Academy, Cairo, Egypt
| | | | - Mohamed Atallah
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Ahmed A Salman
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
41
|
Mardian Y, Yano Y, Ratnasari N, Choridah L, Wasityastuti W, Setyawan NH, Hayashi Y. "Sarcopenia and intramuscular fat deposition are associated with poor survival in Indonesian patients with hepatocellular carcinoma: a retrospective study". BMC Gastroenterol 2019; 19:229. [PMID: 31888500 PMCID: PMC6937974 DOI: 10.1186/s12876-019-1152-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Here, we evaluated the effects of SMI and IMF on the survival of Indonesian HCC patients, whose characteristics differ from those of Japanese patients. Methods SMI and mean muscle attenuation (MA) were evaluated using computed tomography images of the third lumbar vertebra (L3) in a prospective cohort of 100 Indonesian HCC patients. Clinical, laboratory and body composition data were analysed using the Kaplan–Meier method and Cox regression model to investigate which factors are associated with prognosis. Results Of 100 patients, 31 were diagnosed with sarcopenia (L3 SMI value ≤36.2 cm2/m2 for men and ≤ 29.6 cm2/m2 for women), and 65 had IMF deposition (MA value ≤44.4 HU for men and ≤ 39.3 HU for women). These groups had shorter median survival than the reference groups (both P < 0.0001). In multivariable analysis, sarcopenia (hazard ratio [HR], 1.921; P = 0.016), IMF deposition (HR, 3.580; P < 0.001), Barcelona Clinic Liver Cancer (BCLC) stages C and D (HR: 2.396, P < 0.01 and HR: 6.131, P < 0.01, respectively), Japan Integrated Staging (JIS) score 4 (HR: 2.067, P = 0.020), and male gender (HR: 3.211, P < 0.001) were independently associated with mortality. Conclusion Sarcopenia and IMF deposition showed superior value in combination with BCLC stage and JIS score for predicting the survival of Indonesian HCC patients. Increased awareness and strategies to prevent or reverse these factors might improve patient outcomes. (Electric word counts: 249).
Collapse
Affiliation(s)
- Yan Mardian
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiko Yano
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan. .,Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Neneng Ratnasari
- Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Sardjito Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Lina Choridah
- Department of Radiology, Dr. Sardjito Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Widya Wasityastuti
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nurhuda Hendra Setyawan
- Department of Radiology, Dr. Sardjito Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Yoshitake Hayashi
- Division of Infectious Disease Pathology, Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Molecular Medicine & Medical Genetics, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
42
|
Huillard O, Jouinot A, Tlemsani C, Brose MS, Arrondeau J, Meinhardt G, Fellous M, De Sanctis Y, Schlumberger M, Goldwasser F. Body Composition in Patients with Radioactive Iodine-Refractory, Advanced Differentiated Thyroid Cancer Treated with Sorafenib or Placebo: A Retrospective Analysis of the Phase III DECISION Trial. Thyroid 2019; 29:1820-1827. [PMID: 31860408 PMCID: PMC6918875 DOI: 10.1089/thy.2018.0784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Rates of adverse events with sorafenib were higher in the DECISION trial in radioactive iodine-refractory, advanced differentiated thyroid cancer (DTC) than in trials of sorafenib for other tumor types. One possible explanation is that sarcopenia, a known predictive factor of toxicity in patients with cancer, is more common in patients with DTC due to hormone suppressive therapy. Methods: This retrospective exploratory analysis was performed to assess whether the risk of early toxicity leading to dose modification (DMT) with sorafenib was higher in patients with sarcopenia compared with those without sarcopenia. The data set comprised patients from the phase III DECISION trial with a computed tomography scan available to determine muscle mass. The skeletal muscle (SM) cross-sectional area was used to determine the SM index and define sarcopenia. The end points were changes in body composition, DMT, early DMT (within 1 month), severe toxic events (STEs), and early STEs. Results: Overall, 365 patients were eligible for this analysis; baseline characteristics were well balanced between patients receiving sorafenib (n = 180) versus placebo (n = 185). Using a sarcopenia definition of an SM index less than the median sex-specific SM index, approximately half of the patients receiving sorafenib were at risk of sarcopenia (89/180; 49.4%), with wide geographical variation. At 6 months, the mean weight, body mass index, and lean body mass of patients receiving sorafenib were lower than at baseline and significantly lower than for patients receiving placebo (all p < 0.0001). Most DMTs and STEs occurred in the first month of treatment. There was a nonsignificant trend for more early DMTs in patients with sarcopenia compared with those without sarcopenia (55.3% vs. 44.7%, respectively; p = 0.2273). Conclusions: These results show a significant effect of sorafenib on muscle mass. However, there was no association between sarcopenia and DMT or early DMT, in contrast to observations in hepatocellular and renal cell carcinoma.
Collapse
Affiliation(s)
- Olivier Huillard
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
- Department of Medical Oncology, Paris Descartes University, CARPEM, Paris, France
- Address correspondence to: Olivier Huillard, MD, PhD, Department of Medical Oncology, Cochin Hospital, AP-HP, 27 Rue du Faubourg-Saint-Jacques, Paris 75014, France
| | - Anne Jouinot
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
- Department of Medical Oncology, Paris Descartes University, CARPEM, Paris, France
| | - Camille Tlemsani
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
- Department of Medical Oncology, Paris Descartes University, CARPEM, Paris, France
| | - Marcia S. Brose
- Department of Otorhinolaryngology, Head and Neck Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer Arrondeau
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
- Department of Medical Oncology, Paris Descartes University, CARPEM, Paris, France
| | - Gerold Meinhardt
- Clinical Development Oncology; Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Marc Fellous
- Pharmaceuticals Division; Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Yoriko De Sanctis
- Integrated Analysis Statistics, Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Martin Schlumberger
- Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Villejuif, France
| | - Francois Goldwasser
- Department of Medical Oncology, Cochin Hospital, AP-HP, Paris, France
- Department of Medical Oncology, Paris Descartes University, CARPEM, Paris, France
| |
Collapse
|
43
|
Sinclair M. Controversies in Diagnosing Sarcopenia in Cirrhosis-Moving from Research to Clinical Practice. Nutrients 2019; 11:nu11102454. [PMID: 31615103 PMCID: PMC6836123 DOI: 10.3390/nu11102454] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
Sarcopenia, defined as loss of muscle mass and function, is increasingly recognized as a common consequence of advanced cirrhosis that is associated with adverse clinical outcomes. Despite the recent proliferation in publications pertaining to sarcopenia in end-stage liver disease, there remains no single 'best method' for its diagnosis. The inability to identify a gold standard is common to other specialties, including geriatrics from which many diagnostic tools are derived. Controversies in diagnosis have implications for the accuracy and reproducibility of cohort studies in the field, largely prohibit the introduction of sarcopenia measurement into routine patient care and impede the development of clinical trials to identify appropriate therapies. Difficulties in diagnosis are partly driven by our ongoing limited understanding of the pathophysiology of sarcopenia in cirrhosis, the mechanisms by which it impacts on patient outcomes, the heterogeneity of patient populations, and the accuracy, availability and cost of assessments of muscle mass and function. This review discusses the currently studied diagnostic methods for sarcopenia in cirrhosis, and outlines why reaching a consensus on sarcopenia diagnosis is important and suggests potential ways to improve diagnostic criteria to allow us to translate sarcopenia research into improvements in clinical care.
Collapse
Affiliation(s)
- Marie Sinclair
- Department of Medicine, The University of Melbourne, Parkville 3050, Australia.
- Austin Health, Liver Transplant Unit, 145 Studley Road, Heidelberg 3084, Australia.
| |
Collapse
|
44
|
Lillemoe HA, Marcus RK, Kim BJ, Narula N, Davis CH, Shi Q, Wang XS, Aloia TA. Severe Preoperative Symptoms Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection. Ann Surg Oncol 2019; 26:4548-4555. [PMID: 31414293 DOI: 10.1245/s10434-019-07719-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Symptom burden, as measured by patient-reported outcome (PRO) metrics, may have prognostic value in various cancer populations, but remains underreported. The aim of this project was to determine the predictive impact of preoperative patient-reported symptom burden on readiness to return to intended oncologic therapy (RIOT) after oncologic liver resection. METHODS Preoperative factors, including anthropometric analysis of sarcopenia, were collected for patients undergoing oncologic liver resection from 2015 to 2018. All patients reported their preoperative symptom burden using the MD Anderson Symptom Inventory, Gastrointestinal version (MDASI-GI). Time to RIOT readiness was compared using standard statistics. RESULTS Preoperative symptom burden was measured in 107 consecutive patients; 52% had at least one moderate symptom score and 21% reported at least one severe score. Highest rated symptoms were fatigue, disturbed sleep, and distress. For patients reporting a severe preoperative symptom burden, the median time to RIOT readiness was 35 days (interquartile range [IQR] 28-42), compared with 21 days (IQR 21-28) for those without severe symptoms (p < 0.001). On multivariable analysis, severe preoperative symptom burden was independently associated with longer time to RIOT readiness (estimate +7.5 days, 95% confidence interval 2.6-12.3; p = 0.002). CONCLUSIONS Preoperative symptom burden has a substantial impact on time to RIOT readiness, leading to, on average, a 7-day delay in RIOT readiness compared with patients without severe preoperative symptoms. Identifying and targeting severe preoperative symptoms may hasten recovery and improve time to necessary adjuvant therapies.
Collapse
Affiliation(s)
- Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca K Marcus
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bradford J Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nisha Narula
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Catherine H Davis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
45
|
Sawada K, Saitho Y, Hayashi H, Hasebe T, Nakajima S, Ikuta K, Fujiya M, Okumura T. Skeletal muscle mass is associated with toxicity, treatment tolerability, and additional or subsequent therapies in patients with hepatocellular carcinoma receiving sorafenib treatment. JGH Open 2019; 3:329-337. [PMID: 31406927 PMCID: PMC6684515 DOI: 10.1002/jgh3.12167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIM Several reports have demonstrated that skeletal muscle mass influences mortality in patients with hepatocellular carcinoma (HCC) receiving sorafenib treatment; however, there is still controversy with regard to whether skeletal muscle and adipose tissue are associated with the prognosis in HCC patients. We examined the relationship between body composition and prognosis in HCC patients. METHODS We retrospectively analyzed 82 patients with unresectable HCC receiving sorafenib treatment. The skeletal muscle area and adipose tissue area were measured by computed tomography. Patients with low skeletal muscle index (male ≤36.2 cm2/m2, female ≤29.6 cm2/m2) and high visceral to subcutaneous adipose tissue area ratio (VSR) (male ≥ 1.33, female ≥ 0.93) were diagnosed as low skeletal muscle mass (LSMM) and high VSR, respectively. RESULTS A total of 16 and 34 patients were classified as LSMM and high VSR, respectively. LSMM patients frequently experienced serious adverse events (SAEs) and thus had a shorter duration of sorafenib treatment than non-LSMM patients. High VSR was a significant factor for progression-free survival. LSMM patients less frequently received additional/subsequent therapies combined with sorafenib than non-LSMM patients. Multivariate Cox hazard analysis demonstrated that LSMM was a significant factor for the duration of sorafenib treatment. The treatment duration and receiving of additional/subsequent therapies were significantly associated with overall survival (OS) but not with LSMM or high VSR. CONCLUSION LSMM was associated with the frequency of SAEs, treatment tolerability, and treatment duration. LSMM patients were less likely to receive additional/subsequent therapies than non-LSMM patients. Thus, LSMM could identify a subgroup of patients with poor OS.
Collapse
Affiliation(s)
- Koji Sawada
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Yoshinori Saitho
- Department of GastroenterologyAsahikawa Kosei General HospitalAsahikawaJapan
| | - Hidemi Hayashi
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Takumu Hasebe
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Shunsuke Nakajima
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Katsuya Ikuta
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Mikihiro Fujiya
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Toshikatsu Okumura
- Department of Medicine, Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| |
Collapse
|
46
|
Gökyer A, Küçükarda A, Köstek O, Hacıoğlu MB, Sunal BS, Demircan NC, Uzunoğlu S, Solak S, İşsever K, Çiçin I, Erdoğan B. Relation between sarcopenia and dose-limiting toxicity in patients with metastatic colorectal cancer who received regorafenib. Clin Transl Oncol 2019; 21:1518-1523. [PMID: 30868388 DOI: 10.1007/s12094-019-02080-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/02/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sarcopenia is related to poor prognosis and drug toxicities in solid tumors. The aim of our study is to investigate the predisposition of patients with metastatic colorectal carcinoma who started regorafenib treatment to sarcopenia and prolonged survival. METHODS Patients with metastatic colorectal carcinoma who receives regorafenib were search retrospectively. Dose-limiting toxicity was defined as dose reduction or toxicity requiring drug withdrawal. Sarcopenia evaluation was made with computed tomography performed within a month before treatment. Progression-free survival and overall survival were estimated. RESULTS Thirty-six patients were found as suitable for the study. 63.9% of patients were found as basally sarcopenic. Dose-limiting toxicity occured 13 of 23 patients (56.5%) with basal sarcopenia, whereas only 1 of 13 patients (7.6%) with no sarcopenia exhibited dose-limiting toxicity (p = 0.005). Three patients suffered from grade 3-4 toxicity. Hand-foot syndrome, hypertension, and mucosal rash were the most seen side effects. Mean regorafenib treatment duration was 3.36 months. There was no significant difference in the progression-free survival (PFS) and the overall survival (OS) between sarcopenic patients and patients with no sarcopenia. Durations were as OS 24.2 weeks in patients with sarcopenia (95% CI 16.7-31.7), 28.1 weeks in patients with no sarcopenia (95% CI 20.5-35.7) (p = 0.36), and as PFS 14.2 weeks in patients with sarcopenia (95% CI 12.1-16.4), 14.8 weeks in patients with no sarcopenia (95% CI 9.7-20.1) (p = 0.65). CONCLUSION Dose-limiting toxicity was significantly higher in basally sarcopenic patients who were started regorafenib as treatment of metastatic colorectal carcinoma. There was no significant relationship between overall survival and progression-free survival with sarcopenia.
Collapse
Affiliation(s)
- A Gökyer
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey.
| | - A Küçükarda
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey
| | - O Köstek
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey
| | - M B Hacıoğlu
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - B S Sunal
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - N C Demircan
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey
| | - S Uzunoğlu
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey
| | - S Solak
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - K İşsever
- Department of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - I Çiçin
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey
| | - B Erdoğan
- Division of Medical Oncology, Department of Internal Medicine, Trakya University School of Medicine, Edirne, 22030, Turkey
| |
Collapse
|