Introduction: Sarcopenia is an adverse prognostic factor in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Image-based sarcopenia assessment allows a standardized method to assess abdominal skeletal muscle. However, which is an index muscle for sarcopenia remains unclear. Therefore, we investigated whether sarcopenia defined according to different muscle groups with computed tomography (CT) scans can predict the prognosis of HCC after radioembolization. Methods: In this retrospective study, we analyzed patients who underwent radioembolization for unresectable HCC between January 2010 and December 2019. Before treatment, the total abdominal muscle (TAM), psoas muscle (PM), and paraspinal muscle (PS) areas were evaluated using a single CT slice at the third lumbar vertebra. In previous studies, sarcopenia was determined using the TAM, PM, and PS after stratifying by sex. Finally, we investigated each muscle-defined sarcopenia to decide whether or not it can serve as a prognostic factor for overall survival (OS). Results: We included 92 patients (74 men and 18 women). TAM, PM, and PS areas were significantly higher in the men than in the women (all p < 0.05). The patients with sarcopenia defined using PM, but not TAM and PS, exhibited significantly poorer OS than those without sarcopenia (median 15.3 vs. 23.8 months, p = 0.034, 0.821, and 0.341, respectively). After adjustment for clinical variables, such as body mass index, liver function, alpha-fetoprotein level, clinical staging, treatment response, and post-treatment curative therapy, PM-defined sarcopenia (hazard ratio: 1.899, 95% confidence interval: 1.087–3.315) remained an independent predictor for the poor OS. Conclusion: CT-assessed sarcopenia defined using PM was an independent prognostic factor for the poorer prognosis of unresectable HCC after radioembolization.


中文翻译：

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接受放射栓塞治疗的不可切除肝细胞癌患者预后中计算机断层扫描定义的肌肉减少症：评估总腹部、腰大肌和脊柱旁肌肉

简介：肌肉减少症是肝硬化和肝细胞癌 (HCC) 患者的不良预后因素。基于图像的肌肉减少症评估允许采用标准化方法来评估腹部骨骼肌。然而，肌肉减少症的指标肌肉仍不清楚。因此，我们调查了根据不同肌肉群定义的肌肉减少症是否可以通过计算机断层扫描 (CT) 扫描预测 HCC 放射栓塞术后的预后。方法：在这项回顾性研究中，我们分析了 2010 年 1 月至 2019 年 12 月期间因无法切除的 HCC 而接受放射栓塞术的患者。第三腰椎的单个 CT 切片。在以往的研究中，在按性别分层后，使用 TAM、PM 和 PS 确定肌肉减少症。最后，我们调查了每种肌肉定义的肌肉减少症，以确定它是否可以作为总体生存 (OS) 的预后因素。结果：我们纳入了 92 名患者（74 名男性和 18 名女性）。男性的 TAM、PM 和 PS 区域显着高于女性（所有 p < 0.05）。使用 PM 而非 TAM 和 PS 定义的肌肉减少症患者的 OS 明显低于没有肌肉减少症的患者（中位数 15.3 与 23.8 个月，分别为 p = 0.034、0.821 和 0.341）。调整临床变量后，如体重指数、肝功能、甲胎蛋白水平、临床分期、治疗反应和治疗后治疗，PM 定义的肌肉减少症（风险比：1.899，95% 置信区间：1.087– 3. 315) 仍然是较差 OS 的独立预测因子。结论：使用 PM 定义的 CT 评估的肌肉减少症是放射栓塞后无法切除的 HCC 预后较差的独立预后因素。