Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma.
BACKGROUND
A reduction in skeletal muscle mass (sarcopenia) independently predicts poor survival in patients with hepatocellular carcinoma (HCC) undergoing treatment with curative intent. Whether this is due to an increased risk of recurrence and disease specific death, or due to an increased risk of postoperative morbidity and mortality is currently unclear. In this study, we investigate the association between sarcopenia and death in a cohort of HCC patients undergoing treatment with curative intent.


METHODS
Patients undergoing surgical resection or radiofrequency ablation for lesions ≤ 3 cm between 2002 and 2013 were identified. Clinicopathological characteristics, CT-assessed sarcopenia and outcomes were analyzed.


RESULTS
Among 90 patients, 52 (57.8%) were found to be sarcopenic. Sarcopenic patients had a limited overall survival (median: 33 months vs. non-sarcopenic median: 105 months; P = 0.002), but not disease-free survival. Sarcopenia was an independent predictor for overall survival in multivariate Cox-regression analysis (HR 3.756; P = 0.001). Major complications (32.7% vs. 13.2%, P = 0.033) and treatment-related mortality (17.3% vs. 2.6%, P = 0.029) were more frequent in sarcopenic patients.


CONCLUSIONS
Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma, mainly due to an increase in treatment-related mortality.
Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Stef
S
Levolger
Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Mark G
MG
van Vledder
Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Rahat
R
Muslem
Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Marcel
M
Koek
Biomedical Imaging Group Rotterdam, Department of Medical Informatics and Radiology, Erasmus University Medical Center, Rotterdam, Netherlands.|Faculty of Applied Sciences, Delft University of Technology, Delft, Netherlands.
Wiro J
WJ
Niessen
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands.
Rob A
RA
de Man
Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Ron W F
RW
de Bruin
Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Jan N M
JN
Ijzermans
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D009426:Netherlands / Q000453:epidemiology; D055948:Sarcopenia / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
body composition; hepatocellular carcinoma; outcomes; radiofrequency ablation; sarcopenia; surgery