Sarcopenia Is a Negative Prognostic Factor in Patients Undergoing Transarterial Chemoembolization (TACE) for Hepatic Malignancies.

Loosen Loosen,Kuhl Kuhl,Roderburg Roderburg,Bruners Bruners,Schulze-Hagen Schulze-Hagen,Luedde Luedde,Trautwein Trautwein,Tacke Tacke

doi:10.3390/cancers11101503

Loosen Loosen, Kuhl Kuhl + Show 6 more

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https://doi.org/10.3390/cancers11101503

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Abstract

Background and Aims: While transarterial chemoembolization (TACE) represents a standard of therapy for intermediate-stage hepatocellular carcinoma (HCC) and is also routinely performed in patients with liver metastases, it is still debated which patients represent the ideal candidates for TACE therapy in terms of overall survival. Sarcopenia, the degenerative loss of skeletal muscle mass and strength, has been associated with an adverse outcome for various malignancies, but its role in the context of TACE has largely remained unknown. Here, we evaluated the role of sarcopenia on the outcome of patients undergoing TACE for primary and secondary liver cancer. Methods: The patients’ psoas muscle size was measured on axial computed tomography (CT) scans and normalized for the patients’ height squared. This value was referred to as the psoas muscle index (PMI). The PMI was correlated with clinical and laboratory markers. Results: While pre-interventional sarcopenia had no impact on the direct tumor response to TACE, sarcopenic patients with a pre-interventional PMI below our ideal cut-off value of 13.39 mm/m2 had a significantly impaired long-term outcome with a median overall survival of 491 days compared to 1291 days for patients with a high PMI. This finding was confirmed by uni- and multivariate Cox-regression analyses. Moreover, a progressive rapid decline in muscle mass after TACE was a predictor for an unfavorable prognosis. Conclusion: Our data suggest that sarcopenia represents a previously unrecognized prognostic factor for patients undergoing TACE therapy which might yield important information on the patients’ post-interventional outcome and should therefore be implemented into clinical stratification algorithms.

Highlights

For many patients with primary and secondary liver tumors, surgical tumor resection is not feasible due to advanced tumor stage or limited liver function at the time of tumor diagnosis [1,2]
The median age of the study population was 65 years. 41.5% of patients showed an objective response to transarterial chemoembolization (TACE) therapy. 60.0% deceased during the follow-up period
By using a well characterized cohort of 56 patients undergoing TACE therapy for primary or secondary liver cancer, we demonstrated that the presence of sarcopenia represents a negative prognostic parameter in terms of overall survival for these patients

Summary

Introduction

For many patients with primary (e.g., hepatocellular carcinoma) and secondary liver tumors (e.g., metastases of gastrointestinal cancers), surgical tumor resection is not feasible due to advanced tumor stage or limited liver function at the time of tumor diagnosis [1,2]. Different single factors, such as the hepatic functional reserve, tumor distribution and size as well as laboratory parameters have been suggested for patient selection in the context of TACE [4,5] Predictive algorithms such as the assessment for retreatment (ART) score [6,7] or SNACOR We evaluated the role of sarcopenia on the outcome of patients undergoing TACE for primary and secondary liver cancer

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