MYOSTEATOSIS AS A RISK FACTOR FOR HEPATOCELULAR CARCINOMA RECURRENCE AFTER DECEASED DONOR LIVER TRANSPLANTATION
Main Article Content
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.
Keywords:
liver transplantation, hepatocellular carcinoma
Article Details
How to Cite
BEZERRA, Regis Otaviano Franca et al.
MYOSTEATOSIS AS A RISK FACTOR FOR HEPATOCELULAR CARCINOMA RECURRENCE AFTER DECEASED DONOR LIVER TRANSPLANTATION.
Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5733>. Date accessed: 06 sep. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5733.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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25. Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia Impacts on Short- and Long-term Results of Hepatectomy for Hepatocellular Carcinoma. Ann Surg. Jun 2015;261(6):1173-83. doi:10.1097/SLA.0000000000000743
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27. Labelle M, Hynes RO. The initial hours of metastasis: the importance of cooperative host-tumor cell interactions during hematogenous dissemination. Cancer Discov. Dec 2012;2(12): 1091-9. doi:10.1158/2159-8290.CD-12-0329
28. Correa-de-Araujo R, Addison O, Miljkovic I, et al. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol. 2020;11:963. doi:10.3389/fphys.2020.00963
29. Aleixo GFP, Shachar SS, Nyrop KA, Muss HB, Malpica L, Williams GR. Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol. Jan 2020;145: 102839. doi:10.1016/j.critrevonc.2019.102839
30. MacCormick A, Streeter A, Puckett M, Aroori S. The impact of myosteatosis on outcomes following surgery for gastrointestinal malignancy: a meta-analysis. Ann R Coll Surg Engl. Mar 2023;105 (3):203-211. doi:10.1308/rcsann.2021.0290
31. Masetti C, Pugliese N, Lofino L, et al. Myosteatosis Is Not Associated with Complications or Survival in HCC Patients Undergoing Trans Arterial Embolization. J Clin Med. Dec 29 2022; 12(1)doi:10.3390/jcm12010262
32. Bannangkoon K, Hongsakul K, Tubtawee T, Ina N, Chichareon P. Association of myosteatosis with treatment response and survival in patients with hepatocellular carcinoma undergoing chemoembolization: a retrospective cohort study. Sci Rep. Mar 09 2023;13(1):3978. doi:10.1038/s41598-023-31184-9
33. Ebadi M, Wang CW, Lai JC, et al. Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis. J Cachexia Sarcopenia Muscle. Dec 2018;9(6):1053 -1062. doi:10.1002/jcsm.12349
2. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. Mar 2001;56(3):M146-56. doi:10.1093/gerona/56.3.m146
3. Kim TY, Kim MY, Sohn JH, et al. Sarcopenia as a useful predictor for long-term mortality in cirrhotic patients with ascites. J Korean Med Sci. Sep 2014;29(9):1253-9. doi:10.3346/jkms.2014.29.9.1253
4. Zhang G, Meng S, Li R, Ye J, Zhao L. Clinical significance of sarcopenia in the treatment of patients with primary hepatic malignancies, a systematic review and meta-analysis. Oncotarget. Nov 24 2017;8(60):102474-102485. doi:10.18632/oncotarget.19687
5. Kamachi S, Mizuta T, Otsuka T, et al. Sarcopenia is a risk factor for the recurrence of hepatocellular carcinoma after curative treatment. Hepatol Res. Feb 2016;46(2):201-8. doi:10.1111/hepr.12562
6. Englesbe MJ, Patel SP, He K, et al. Sarcopenia and mortality after liver transplantation. J Am Coll Surg. Aug 2010;211(2):271-8. doi:10.1016/j.jamcollsurg.2010.03.039
7. Kaido T, Ogawa K, Fujimoto Y, et al. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transplant. Jun 2013;13(6):1549-56. doi:10.1111/ajt.12221
8. Hamaguchi Y, Kaido T, Okumura S, et al. Impact of quality as well as quantity of skeletal muscle on outcomes after liver transplantation. Liver Transpl. Nov 2014;20(11):1413-9. doi:10.1002/lt.23970
9. Kim YR, Park S, Han S, et al. Sarcopenia as a predictor of post-transplant tumor recurrence after living donor liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Sci Rep. May 08 2018;8(1):7157. doi:10.1038/s41598-018-25628-w
10. Montano-Loza AJ, Angulo P, Meza-Junco J, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle. May 2016;7(2):126-35. doi:10.1002/jcsm.12039
11. Boutin RD, Yao L, Canter RJ, Lenchik L. Sarcopenia: Current Concepts and Imaging Implications. AJR Am J Roentgenol. Sep 2015;205 (3):W255-66. doi:10.2214/AJR.15.14635
12. Lang PO, Michel JP, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology. 2009;55(5):539-49. doi:10.1159/000211949
13. Vitale A, Farinati F, Noaro G, et al. Restaging Patients With Hepatocellular Carcinoma Before Additional Treatment Decisions: A Multicenter Cohort Study. Hepatology. Oct 2018;68(4):1232-1244. doi:10.1002/hep.30185
14. Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. Mar 2020;21(3):300-307.e2. doi:10.1016/j.jamda.2019.12.012
15. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. Jan 01 2019;48(1):16-31. doi:10.1093/ageing/afy169
16. Dasarathy S, Merli M. Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol. Dec 2016;65(6):1232-1244. doi:10.1016/j.jhep.2016.07.040
17. Kumar R, Prakash SS, Priyadarshi RN, Anand U. Sarcopenia in Chronic Liver Disease: A Metabolic Perspective. J Clin Transl Hepatol. Dec 28 2022; 10(6):1213-1222. doi:10.14218/JCTH.2022.00239
18. Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol. Feb 2012;10(2):117-25. doi:10.1016/j.cgh.2011.08.016
19. Grąt K, Pacho R, Grąt M, Krawczyk M, Zieniewicz K, Rowiński O. Impact of Body Composition on the Risk of Hepatocellular Carcinoma Recurrence After Liver Transplantation. J Clin Med. Oct 13 2019;8(10)doi:10.3390/jcm8101672
20. D’Arcangelo F, Zanetto A, Aliberti C, et al. The impact of sarcopenia on the outcome of patients with cirrhosis with and without hepatocellular carcinoma who undergo liver transplantation. Hepatoma Research2021. p. 4.
21. Beumer BR, van Vugt JLA, Sapisochin G, et al. Impact of muscle mass on survival of patients with hepatocellular carcinoma after liver transplantation beyond the Milan criteria. J Cachexia Sarcopenia Muscle. Oct 2022;13(5):2373-2382. doi:10.1002/jcsm.13053
22. Tan Y, Duan T, Li B, et al. Sarcopenia defined by psoas muscle index independently predicts long-term survival after living donor liver transplantation in male recipients. Quant Imaging Med Surg. Jan 2022;12(1):215-228. doi:10.21037/qims-21-314
23. Kobayashi A, Kaido T, Hamaguchi Y, et al. Impact of Sarcopenic Obesity on Outcomes in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. Ann Surg. May 2019;269(5):924-931. doi:10.1097/SLA.0000000000002555
24. Yabusaki N, Fujii T, Yamada S, et al. Adverse impact of low skeletal muscle index on the prognosis of hepatocellular carcinoma after hepatic resection. Int J Surg. Jun 2016;30:136-42. doi:10.1016/j.ijsu.2016.04.049
25. Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia Impacts on Short- and Long-term Results of Hepatectomy for Hepatocellular Carcinoma. Ann Surg. Jun 2015;261(6):1173-83. doi:10.1097/SLA.0000000000000743
26. Lutz CT, Quinn LS. Sarcopenia, obesity, and natural killer cell immune senescence in aging: altered cytokine levels as a common mechanism. Aging (Albany NY). Aug 2012;4(8):535-46. doi:10.18632/aging.100482
27. Labelle M, Hynes RO. The initial hours of metastasis: the importance of cooperative host-tumor cell interactions during hematogenous dissemination. Cancer Discov. Dec 2012;2(12): 1091-9. doi:10.1158/2159-8290.CD-12-0329
28. Correa-de-Araujo R, Addison O, Miljkovic I, et al. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol. 2020;11:963. doi:10.3389/fphys.2020.00963
29. Aleixo GFP, Shachar SS, Nyrop KA, Muss HB, Malpica L, Williams GR. Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol. Jan 2020;145: 102839. doi:10.1016/j.critrevonc.2019.102839
30. MacCormick A, Streeter A, Puckett M, Aroori S. The impact of myosteatosis on outcomes following surgery for gastrointestinal malignancy: a meta-analysis. Ann R Coll Surg Engl. Mar 2023;105 (3):203-211. doi:10.1308/rcsann.2021.0290
31. Masetti C, Pugliese N, Lofino L, et al. Myosteatosis Is Not Associated with Complications or Survival in HCC Patients Undergoing Trans Arterial Embolization. J Clin Med. Dec 29 2022; 12(1)doi:10.3390/jcm12010262
32. Bannangkoon K, Hongsakul K, Tubtawee T, Ina N, Chichareon P. Association of myosteatosis with treatment response and survival in patients with hepatocellular carcinoma undergoing chemoembolization: a retrospective cohort study. Sci Rep. Mar 09 2023;13(1):3978. doi:10.1038/s41598-023-31184-9
33. Ebadi M, Wang CW, Lai JC, et al. Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis. J Cachexia Sarcopenia Muscle. Dec 2018;9(6):1053 -1062. doi:10.1002/jcsm.12349