Impact of sarcopenia evaluated using the total psoas area (TPA) in patients undergoing Y-90 radioembolization for hepatocellular carcinoma (HCC).

Abstract

217 Background: Severe skeletal muscle depletion, or sarcopenia, is an independent predictor of clinical outcomes in multiple gastrointestinal cancers. This marker of nutritional status has been defined using the TPA which is measured on a single cross sectional CT image at the L4 vertebral body level. We sought to evaluate whether TPA was predictive of outcomes in those patients with unresectable HCC receiving Y-90 radioembolization. Methods: In an IRB approved database consisting of HCC patients treated with Y-90 radioembolization, 111 patients met our selection criteria of treatment from 2009-2014. To be eligible for the study, patients were included prior to their first injection of Y-90 if they had CT imaging available that included the L4 vertebral level that could be transferred to the treatment planning software system. Of these, 73 patients met criteria and were included in the final analysis. The L4 vertebra was identified on axial CT imaging and the psoas muscle was manually contoured bilaterally. Sarcopenia was defined by the presence of the psoas area in less than the median of the cohort. Results: Sarcopenia was associated with a significantly decreased overall survival (p = 0.013) The mean age of the cohort was 67.6 years (range, +/- 9.45) consisting of 84% male and 16% female patients. Difference in age or gender did not correlate significantly with survival. The median survival time in the “low” (sarcopenic) group was 10.46 months (range, +/- 1.21), whereas the median survival in the “high” group was 18.02 months (range, +/-4.26). The median survival for the entire cohort was 12.86 months. OS at 30 months was 15.4% in the sarcopenic group and 30.2 % in the “high” group. TPA in the upper quartile was associated with a survival benefit compared to the bottom quartiles. The presence of sarcopenia was associated with an increased risk of mortality (HR = 2.049; p = 0.015 CI: 01.150, 3.649). Conclusions: Measurement of the psoas area using TPA is a simple objective method to detect frailty and is predictive of overall survival outcome following Y-90 radioembolization