Abstract
The aim of this study was to assess the annualized changes in body composition, including skeletal muscle, subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT) before, during, and after sorafenib treatment in patients with hepatocellular carcinoma (HCC). This retrospective study evaluated 61 HCC patients treated with sorafenib. Annualized changes (Δ; cm2/m2/year) in skeletal muscle index (SMI), SAT index (SATI), and VAT index (VATI), which were defined as the cross-sectional areas (cm2) of those areas on computed tomography normalized by the square of one’s height (m2), before (pre), during (during), and after (post) sorafenib treatment, were calculated. Patients within the 20th percentile cutoffs for these indices were classified into the rapid depletion group and the effects of these values on survival were analyzed using the Kaplan-Meier analysis and Cox proportional-hazards model. Annualized depletion rates of SMI (ΔSMIpre: −3.5, ΔSMIduring: −3.5, ΔSMIpost: −8.0) and VATI (ΔVATIpre: −3.2, ΔVATIduring: −2.8, ΔVATIpost: −15.1) accelerated after the cancellation of sorafenib, whereas that of SATI (ΔSATIpre: −4.8, ΔSATIduring; −7.6, ΔSATIpost; −8.0) had already accelerated during sorafenib treatment. Patients with rapid depletion of ΔSATIduring experienced significantly worse survival rates (p < 0.001), and it was an independent predictor of survival (p = 0.009), together with therapeutic effect (p < 0.001). Rapid depletion of SAT during sorafenib treatment can be used to predict survival in patients with HCC.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common global malignancies; more than half a million people are diagnosed with HCC annually [1]
We have previously indicated that skeletal muscle decreases according to worsening liver functional reserve and larger tumor size in HCC [21]
Accelerated skeletal muscle and adipose tissue depletions are reported to be associated with poor survival rates in patients with advanced cancers, including HCC [14,15,16,17,18,22,23]
Summary
Hepatocellular carcinoma (HCC) is one of the most common global malignancies; more than half a million people are diagnosed with HCC annually [1]. Sorafenib is widely used for the treatment of patients with advanced HCC [4,5]; several adverse events, including hand–foot syndrome (HFS), fatigue, weight loss, and gastrointestinal events, such as anorexia, diarrhea, nausea, and vomiting often occur when using this agent [6]. Once these adverse gastrointestinal tract events occur, malnutrition can result, causing reductions in body weight and unfavorable changes in body composition, such as sarcopenia, depletion of adipose tissues, and cachexia
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