Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments

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Abstract

Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients’ survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed.

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Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma.

Naoto Fujiwara, Hayato Nakagawa, Yotaro Kudo … (2015)

Obesity defined by body mass index (BMI) significantly increases the risk of hepatocellular carcinoma (HCC). In contrast, not only obesity but also underweight is associated with poor prognosis in patients with HCC. Differences in body composition rather than BMI were suggested to be true determinants of prognosis. However, this hypothesis has not been demonstrated conclusively.

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Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria.

Hiroki Nishikawa, Makoto Shiraki, Akira Hiramatsu … (2016)

Sarcopenia is defined by muscle loss and muscle dysfunction. Sarcopenia is classified into primary and secondary types, based on the cause. Primary sarcopenia is mainly aging-related sarcopenia, whereas secondary sarcopenia is the reduced muscle mass and strength that accompanies an underlying disease. Given the essential role of the liver in metabolism, secondary sarcopenia due to nutritional disorders or other factors can frequently occur in liver disease. In 2015, the Japan Society of Hepatology (JSH) decided to establish its own assessment criteria for sarcopenia in liver disease because the number of liver disease patients with sarcopenia is expected to increase and there is cumulative evidence to indicate sarcopenic patients have poor clinical outcomes. A working group to create assessment criteria for sarcopenia has thus been established by the JSH. In this article, we summarize the current knowledge with regard to sarcopenia and present the assessment criteria for sarcopenia in liver disease proposed by the JSH (1st edition). To the best of our knowledge, this is globally the first proposed assessment criteria for sarcopenia specializing in liver disease.

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Prognostic value of sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

Gaeun Kim, Seong Kang, Moon Kim … (2017)

Background Sarcopenia is a common syndrome in chronic diseases such as liver cirrhosis. The association between sarcopenia and outcomes, such as complications and survival has recently been described in various patient groups. However, study results remain inconclusive. Therefore, the aim of this study was to systematically review the impact of sarcopenia on outcome in patients with cirrhosis. Methods and findings We conducted a systematic review (SR) and meta-analysis (MA) on the impact of sarcopenia on outcome in liver cirrhosis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Of the 312 studies identified, 20 were eligible according to our inclusion criteria. Most of the studies used CT to diagnose sarcopenia. Two studies used bioelectrical impedance analysis (BIA), 10 studies used skeletal muscle index (SMI) and 8 studies used total psoas muscle area (TPA). Seven studies included Asian participants and the remaining 13 studies included Western participants. The prevalence rate of sarcopenia among participants was mean 48.1%, and appeared more among men with a rate of 61.6% whereas the rate was 36% for women. With respect to clinical outcomes, patients with sarcopenia had poorer survival rates and an increased risk of complications such as infection compared to those without sarcopenia. According to the analysis of race subgroup, Asians had a HR 2.45 (95% confidence interval (CI) = 1.44–4.16, P = 0.001) of mortality whereas Westerners had a HR 1.45 (95% CI = 1.002–2.09, P<0.05). Conclusions Based on this SR and MA, the presence of sarcopenia is related to a poor prognosis and occurrence of cirrhotic complications and could be used for risk assessment. Moreover, Asian participants had higher mortality related to sarcopenia compared to the Western participants.

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Author and article information

Contributors

Giovanni Marasco:

ORCID: http://orcid.org/0000-0001-7167-8773

giovanni.marasco4@unibo.it

Journal

Journal ID (nlm-ta): J Gastroenterol

Journal ID (iso-abbrev): J. Gastroenterol

Title: Journal of Gastroenterology

Publisher: Springer Singapore (Singapore )

ISSN (Print): 0944-1174

ISSN (Electronic): 1435-5922

Publication date (Electronic): 3 August 2020

Publication date PMC-release: 3 August 2020

Publication date (Print): 2020

Volume: 55

Issue: 10

Pages: 927-943

Affiliations

[1 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Department of Medical and Surgical Sciences, , University of Bologna, ; Via Massarenti 9, 40126 Bologna, Italy

[2 ]GRID grid.412311.4, Radiology Unit, , Sant’Orsola Malpighi Hospital, ; Via Albertoni 4, 40138 Bologna, Italy

[3 ]GRID grid.411475.2, ISNI 0000 0004 1756 948X, Gastroenterology Unit, , University Hospital Borgo Trento, ; Verona, Italy

Author information

Giovanni Marasco http://orcid.org/0000-0001-7167-8773

Article

Publisher ID: 1711

DOI: 10.1007/s00535-020-01711-w

PMC ID: 7519899

PubMed ID: 32748172

SO-VID: ff3a612f-0a27-40a4-956e-d4af98dd9e8e

License:

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