Impact of Low Skeletal Muscle Mass on Long-Term Outcomes in Hepatocellular Carcinoma Treated with Trans-Arterial Radioembolization: A Retrospective Multi-Center Study
Author:
Nam Heechul12ORCID, Yang Hyun12ORCID, Chun Ho Soo3, Lee Han Ah3ORCID, Nam Joon Yeul4, Jang Jeong Won12ORCID, Seo Yeon Seok5, Kim Do Young6ORCID, Kim Yoon Jun4ORCID, Bae Si Hyun12ORCID
Affiliation:
1. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea 2. Liver Research Center, The Catholic University, Seoul 06591, Republic of Korea 3. Departments of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea 4. Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea 5. Department of Internal Medicine, College of Medicine, Korea University, Anam Hospital, Seoul 02841, Republic of Korea 6. Department of Internal Medicine, Yonsei Liver Center, College of Medicine, Yonsei University, Severance Hospital, Seoul 03772, Republic of Korea
Abstract
Trans-arterial radioembolization (TARE) is a form of radiation therapy performed for hepatocellular carcinoma (HCC) via selective intra-arterial injection of Yttrium-90-loaded microspheres. This was a multi-center retrospective study of consecutive patients with HCC who underwent TARE between July 2009 and May 2019. Using pre-treatment computed tomography imaging, the total cross-sectional area (cm2) of the abdominal skeletal muscle at the third lumbar vertebra was measured. The skeletal muscle index (SMI) was calculated by normalizing the muscle area to patient height. In total, 347 patients (median age, 65 years; 284 male) were included in the study. A total of 108 (31.1%) patients had portal vein tumor thrombus (PVTT), and 126 (36.3%) were classified as LSMM. The median overall survival (OS) was 28.1 months (95% CI, 24.8–35.7), and median progression-free survival was 8.0 months (95% CI, 6.4–9.4). Multivariate Cox regression analysis revealed that LSMM (hazard ratio [HR], 1.36; 95% CI, 1.00–1.85, p = 0.05), PVTT (HR, 1.82; 95% CI, 1.33–2.49, p < 0.01), alpha-fetoprotein (AFP) (≥200 ng/mL) (HR 1.41; 95% CI, 1.04–1.92, p = 0.03), and albumin–bilirubin grade (2–3) (HR 1.74; 95% CI, 1.24–2.43, p < 0.01) were independently associated with poor OS. TARE provided favorable long-term outcomes for patients with advanced HCC. Pre-treatment LSMM independently associated with survival, suggesting its utility as a surrogate biomarker for identifying TARE candidates.
Funder
National Research Foundation of Korea
Subject
Cancer Research,Oncology
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