Impact of sarcopenia on outcomes following intra-arterial therapy of hepatic malignancies.
BACKGROUND
Assessment of patient performance status is often subjective. Sarcopenia--measurement of muscle wasting--may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT).


METHODS
Total psoas area (TPA) was measured on cross-sectional imaging in 216 patients undergoing IAT of hepatic malignancies between 2002 and 2012. Sarcopenia was defined as TPA in the lowest sex-specific quartile. Impact of sarcopenia was assessed relative to other clinicopathological factors.


RESULTS
Indications for IAT included hepatocellular carcinoma (51 %), intrahepatic cholangiocarcinoma (13 %), colorectal liver metastasis (7 %), or other metastatic disease (30 %). Median TPA among men (568 mm(2)/m(2)) was greater than women (413 mm(2)/m(2)). IAT involved conventional chemoembolization (54 %), drug-eluting beads (40 %), or yttrium-90 (6 %). Median tumor size was 5.8 cm; most patients had multiple lesions (74 %). Ninety-day mortality was 9.3 %; 3-year survival was 39 %. Factors associated with risk of death were tumor size (HR = 1.84) and Child's score (HR = 2.15) (all P < 0.05). On multivariate analysis, sarcopenia remained independently associated with increased risk of death (lowest vs. highest TPA quartile, HR = 1.84; P = 0.04). Sarcopenic patients had a 3-year survival of 28 vs. 44 % for non-sarcopenic patients.


CONCLUSIONS
Sarcopenia was an independent predictor of mortality following IAT with sarcopenic patients having a twofold increased risk of death. Sarcopenia is an objective measure of frailty that can help clinical decision-making regarding IAT for hepatic malignancies.
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600 N. Wolfe Street, Baltimore, 21287, MD, USA.
Rebecca M
RM
Dodson
Amin
A
Firoozmand
Omar
O
Hyder
Vania
V
Tacher
David P
DP
Cosgrove
Nikhil
N
Bhagat
Joseph M
JM
Herman
Christopher L
CL
Wolfgang
Jean-Francois H
JF
Geschwind
Ihab R
IR
Kamel
Timothy M
TM
Pawlik
D000368:Aged; D001650:Bile Duct Neoplasms; D001653:Bile Ducts, Intrahepatic; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000401:mortality; D016461:Chemoembolization, Therapeutic; D018281:Cholangiocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016658:Psoas Muscles / Q000473:pathology; D055948:Sarcopenia