The Significance Of Sarcopenia Evaluation In The Prognostic Prediction And Treatments Of Hepatocellular Carcinoma

AIM: This study aimed to evaluate the diagnostic value of bicipital muscle area(BMA)in sarcopenia,analyze the impact of sarcopenia on the prognosis of patients with hepatocellular carcinoma(HCC),and investigate the efficacy of nutritional support therapy on HCC patients with sarcopenia.MATERIALS AND METHODS: From October 2015 to December 2017,417 patients with HCC hospitalized in our center were included.L3 skeletal muscle area and BMA were measured by CT.The diagnosis of sarcopenia was based on L3 skeletal muscle index.The area under receiver operating characteristic curve(AUC)was calculated to evaluate the accuracy of BMA in the diagnosis of sarcopenia.Logistic regression analysis was used to identify factors related to sarcopenia.Overall survival was estimated using Kaplan-Meier method and compared by log-rank test.COX regression analysis was used to determine risk factors affecting the prognosis of patients with HCC.A prospective study was conducted in 182 patients with HCC hospitalized in our center between March2016 and December 2017.Patients were divided into treatment and control groups according to whether they had nutritional support therapy.Overall survival was compared between the two groups.RESULT : A total of 119(28.5%)patients with HCC were diagnosed with sarcopenia.The AUC of BMA in the diagnosis of sarcopenia was 0.821(P<0.001).The optimal cut-off of BMA for diagnosing sarcopenia was 4.115 cm2,with a sensitivity of 91.8% and a specificity of 63.4%.Multiple logistic regression analysis showed that portal vein tumor thrombus(OR: 3.594,95%CI:1.189-10.871,P = 0.023),ascites(OR: 2.565,95%CI: 0.960-6.852,P = 0.043)and high NRS2002 nutrition score(OR: 2.115,95%CI: 1.618-2.763,P < 0.001)were independent risk factors of sarcopenia in patients with HCC.The median survival in HCC patients with sarcopenia was significantly lower than that in those without sarcopenia(6.2 months versus 13.9 months,P < 0.001).Multiple Cox regression analysis also identified sarcopenia(HR: 2.796,95%CI:1.579-4.950,P < 0.001)as an independent risk factor of overall survival of patients with HCC.The 1-year and 2-year overall survival rates did not show significant difference between the treatment group(37.6% and 24.7%)and control group(45.3% and 10.3%)(P = 0.447).CONCLUTION: BMA performed well in the identification of sarcopenia in patients with HCC and could be used as a new basis for the diagnosis of sarcopenia.portal vein tumor thrombus,ascites and high NRS2002 nutrition score were independent risk factors for sarcopenia.HCC patients with sarcopenia had decreased overall survival and sarcopenia was an independent risk factor of overall survival in HCC patients.Further studies are needed to validate the efficacy of nutritional support therapy in improving long-term survival in HCC patients with sarcopenia.