Abstract
Sarcopenia has been associated with lower overall survival in patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing surgical resection, TACE, TARE, or transplantation. This monocentric study evaluated the prognostic significance of sarcopenia in patients affected by HCC who received bland transarterial embolization (TAE) therapy, by analyzing its impact on survival and treatment-related complications. All consecutive patients who underwent the 1st TAE between March 1st 2011 and July 1st 2019 in our Institution were retrospectively studied. To evaluate sarcopenia, the skeletal muscle index (SMI) was calculated by normalizing the cross-sectional muscle area at the level of L3 on an abdominal CT scan prior to embolization (cm2) by patient height (m2). SMI cut-off values for sarcopenia were considered ≤ 39 cm2/m2 for women and ≤55 cm2/m2 for men. Data about age, gender, body mass index (BMI), underlying liver disease, liver function, MELD score, Child-Pugh score, multifocal disease, performance status, previous interventions, length of stay (LOS), complications after the procedure, readmission rate within 30 days, survival time from TAE and total number and type of TAE received following the first procedure were collected. From 2011 to 2019, 142 consecutive patients underwent 305 TAEs. Observation time ranged from 1.4 to 100.5 months (median 20.1 SD = 22). Sarcopenia at baseline was present in 121 (85%) patients. Overall 87 (61.2%) patients died during follow-up with survival rates at 1-, 2-, 3-, 4-, and 5-year of 71%, 41%, 22%, 16% and 11% respectively. After multivariate analysis sarcopenia (HR = 2.22, p = 0.046), previous ablation/resection (HR = 0.51, p = 0.005) and multifocal disease (HR = 1.84, p = 0.02) were associated with reduced survival. Sarcopenia did not influence the safety of TAE in terms of LOS (2 days vs 1.5 days, p = 0.2), early complications rate (8% vs 5%, p = 0.5) and readmission rate within 30 days (7% vs 5%, p = 0.74). Sarcopenia, estimated by the L3SMI method, is an emerging prognostic factor in patients with HCC undergoing bland TAE therapy as it is associated with increased mortality, without impairing the safety of the locoregional treatment. Measures to ameliorate the SMI, such as nutritional support and physical exercise, should be evaluated in clinical trials for HCC patients receiving liver embolization to determine their impact on overall survival.
Highlights
Patients affected by Hepatocellular Carcinoma (HCC) are often unfit for curative surgery due to advanced disease at diagnosis, portal hypertension, reduced liver function, multinodular disease and concomitant comorbidities [1,2]
Sarcopenia, estimated by the L3SMI method, is an emerging prognostic factor in patients with HCC undergoing bland transarterial embolization (TAE) therapy as it is associated with increased mortality, without impairing the safety of the locoregional treatment
Measures to ameliorate the skeletal muscle index (SMI), such as nutritional support and physical exercise, should be evaluated in clinical trials for HCC patients receiving liver embolization to determine their impact on overall survival
Summary
Patients affected by Hepatocellular Carcinoma (HCC) are often unfit for curative surgery due to advanced disease at diagnosis, portal hypertension, reduced liver function, multinodular disease and concomitant comorbidities [1,2]. Bland transarterial embolization (TAE) has been shown to improve patient survival and tumor response with similar efficacy when compared to transarterial chemoembolization (TACE) or transarterial radioembolization (TARE) [4,5]. Survival rates following TAE are extremely heterogeneous as patients who undergo TAE vary significantly in terms of liver function, age and concomitant comorbidities. On top of these differences, HCC burden (number of nodules and vascular invasion) and its molecular features play a significant role in the survival post-TAE [7]. Data regarding the impact of sarcopenia in patients receiving TAE monotherapy are lacking
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