Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis
Background: Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim: To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material an...
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doaj-8ad0a70044e84d138ebe69444233a5362021-06-09T05:51:06ZengElsevierAnnals of Hepatology1665-26812017-01-01161107114Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First DiagnosisPaola Begini0Elia Gigante1Giulio Antonelli2Francesco Carbonetti3Elsa Iannicelli4Giulia Anania5Barbara Imperatrice6Adriano Maria Pellicelli7Gianfranco Delle Fave8Massimo Marignani9Digestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy; Correspondence and reprint request:Digestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyDigestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyRadiology Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyRadiology Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyDigestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyDigestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyLiver Unit, San Camillo Forlanini Hospital, Rome, ItalyDigestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyDigestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, ItalyBackground: Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim: To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and Methods: Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results: Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions: This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.http://www.sciencedirect.com/science/article/pii/S1665268119303679Muscle wastingCirrhosisPrognosisSkeletal muscle indexLiver Cancer |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Paola Begini Elia Gigante Giulio Antonelli Francesco Carbonetti Elsa Iannicelli Giulia Anania Barbara Imperatrice Adriano Maria Pellicelli Gianfranco Delle Fave Massimo Marignani |
spellingShingle |
Paola Begini Elia Gigante Giulio Antonelli Francesco Carbonetti Elsa Iannicelli Giulia Anania Barbara Imperatrice Adriano Maria Pellicelli Gianfranco Delle Fave Massimo Marignani Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis Annals of Hepatology Muscle wasting Cirrhosis Prognosis Skeletal muscle index Liver Cancer |
author_facet |
Paola Begini Elia Gigante Giulio Antonelli Francesco Carbonetti Elsa Iannicelli Giulia Anania Barbara Imperatrice Adriano Maria Pellicelli Gianfranco Delle Fave Massimo Marignani |
author_sort |
Paola Begini |
title |
Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis |
title_short |
Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis |
title_full |
Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis |
title_fullStr |
Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis |
title_full_unstemmed |
Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis |
title_sort |
sarcopenia predicts reduced survival in patients with hepatocellular carcinoma at first diagnosis |
publisher |
Elsevier |
series |
Annals of Hepatology |
issn |
1665-2681 |
publishDate |
2017-01-01 |
description |
Background: Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim: To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and Methods: Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results: Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions: This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population. |
topic |
Muscle wasting Cirrhosis Prognosis Skeletal muscle index Liver Cancer |
url |
http://www.sciencedirect.com/science/article/pii/S1665268119303679 |
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