Abstract
INTRODUCTION: Sarcopenia is defined as loss of muscle mass. Besides, myosteatosis is characterized by increased proportion of intermuscular and intramuscular fat. We aimed evaluate the impact of sarcopenia and myosteatosis in hepatocellular carcinoma (HCC) recurrence after liver transplantation.
METHODS: Retrospective study of consecutive patients with HCC who underwent liver transplantation in a single institution. Right psoas attenuation (PAt) was measured in Hounsfield units at the level of the third lumbar vertebra. Partial volume of the right psoas (PV) was measured up to the level of the iliac crest. Sarcopenia was defined based on the median values found in each measured parameter.
RESULTS: Our study sample included 206 patients. The median follow-up was 4.83 years (IQR 2.35–7.82 years). Overall survival was 84% at 1 year and 75% at 3 years. There were 16 patients (7.76%) with HCC recurrence. Sarcopenia had no impact on overall survival (p<0.68) or disease-free survival (p<0.679). The continuous value of psoas attenuation was negatively associated with the risk of HCC recurrence (p=0.017). Univariate analysis for HCC recurrence identified micro- and macrovascular invasion, preoperative AFP greater than 200, pathological staging beyond Milan Criteria and presence of myosteatosis as significant risk factors. Multivariate analysis only confirmed myosteatosis as an independent risk factor for recurrence (HH 5.88, 95% CI 1.52; 25, and p=0.005).
CONCLUSIONS: Myosteatosis was associated with HCC recurrence after liver transplantation.