Abstract
BackgroundA large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Here, we evaluated the effects of SMI and IMF on the survival of Indonesian HCC patients, whose characteristics differ from those of Japanese patients.MethodsSMI and mean muscle attenuation (MA) were evaluated using computed tomography images of the third lumbar vertebra (L3) in a prospective cohort of 100 Indonesian HCC patients. Clinical, laboratory and body composition data were analysed using the Kaplan–Meier method and Cox regression model to investigate which factors are associated with prognosis.ResultsOf 100 patients, 31 were diagnosed with sarcopenia (L3 SMI value ≤36.2 cm2/m2 for men and ≤ 29.6 cm2/m2 for women), and 65 had IMF deposition (MA value ≤44.4 HU for men and ≤ 39.3 HU for women). These groups had shorter median survival than the reference groups (both P < 0.0001). In multivariable analysis, sarcopenia (hazard ratio [HR], 1.921; P = 0.016), IMF deposition (HR, 3.580; P < 0.001), Barcelona Clinic Liver Cancer (BCLC) stages C and D (HR: 2.396, P < 0.01 and HR: 6.131, P < 0.01, respectively), Japan Integrated Staging (JIS) score 4 (HR: 2.067, P = 0.020), and male gender (HR: 3.211, P < 0.001) were independently associated with mortality.ConclusionSarcopenia and IMF deposition showed superior value in combination with BCLC stage and JIS score for predicting the survival of Indonesian HCC patients. Increased awareness and strategies to prevent or reverse these factors might improve patient outcomes. (Electric word counts: 249).
Highlights
A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival
Twenty-four patients were excluded because computed tomography (CT) scan imaging data and/or required clinical/laboratory data were missing or because of concomitant malignancies
SD Standard deviation, BCLC Barcelona Clinic Liver Cancer, ECOG PS Eastern Cooperative Oncology Group Performance Status, tumour node metastasis (TNM) Tumour-node-metastasis, LCSGJ Liver Cancer Study Group of Japan, TNM Classification system, American Joint Committee on Cancer (AJCC) American Joint Committee of on Cancer, JIS Japan Integrated Staging, PEIT Percutaneous ethanol injection therapy, radiofrequency ablation (RFA) Radiofrequency ablation, Transarterial chemoembolization (TACE) Transarterial chemoembolisation higher mortality rate (HR, 3.580; 95% confidence intervals (CI), 1.895–6.764; P < 0.001) in multivariate analysis (Table 2), suggesting that IMF deposition is associated with the progression of liver disease
Summary
A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Mardian et al BMC Gastroenterology (2019) 19:229 study performed in Indonesia demonstrated that most patients are diagnosed at intermediate to advanced stages (Barcelona Clinic Liver Cancer [BCLC] stage B or C), are relatively young (mean age, 54 years), and have a poor prognosis with a median overall survival of 138 days [6]. Previous studies demonstrated that changes in body composition are associated with poor outcomes in cancer patients including HCC [9]. A large-scale retrospective study conducted in Japan revealed that loss of skeletal muscle, known as sarcopenia, and intramuscular fat (IMF) deposition, measured by computed tomography (CT), are related to the prognosis of HCC [2]. The pathophysiological mechanism linking sarcopenia and IMF deposition may include insulin resistance and increased levels of inflammatory cytokines, which are associated with the progression of HCC [2, 10]
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