MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma (original) (raw)

Abstract

Purpose

To evaluate the influence of sarcopenia on survival in patients with hepatocellular carcinoma (HCC) treated with 90Y radioembolization.

Materials and Methods

This single-center retrospective cohort study analyzed 82 consecutive patients (65 men and 17 women, mean age 65 years, range 31–83 years) with HCC treated with 90Y radioembolization between December 2013 and December 2017. Sarcopenia was assessed on pre-procedure MRI performed within 100 days prior to 90Y radioembolization by segmenting the paraspinal musculature at the level of the superior mesenteric artery origin and subtracting fat-intensity pixels to yield fat-free muscle area (FFMA). Sarcopenia was defined as FFMA ≤31.97 cm2 for men and ≤28.95 cm2 for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records.

Results

Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days–58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease.

Conclusion

Sarcopenia was associated with increased 180-day and 1-year mortality in HCC patients undergoing 90Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.

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References

  1. Bruix J, Llovet JM. Major achievements in hepatocellular carcinoma. Lancet. 2009;373:614–6.
    Article Google Scholar
  2. Bruix J, Sherman M. American association for the study of liver diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020–1022.
  3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: european consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Aging. 2010;39:412–23.
    Article Google Scholar
  4. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31:1539–47.
    Article Google Scholar
  5. Iritani S, Imai K, Takai K, et al. Skeletal muscle depletion is an independent prognostic factor for hepatocellular carcinoma. J Gastroenterol. 2015;50:323–32.
    Article CAS Google Scholar
  6. Meza-Junco J, Montano-Loza AJ, Baracos VE, et al. Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. J Clin Gastroenterol. 2013;47:861–70.
    Article Google Scholar
  7. Ha Y, Kim D, Han S, et al. Sarcopenia predicts prognosis in patients with newly diagnosed hepatocellular carcinoma independent of tumor stage and liver function. Cancer Res Treat. 2018;50:843–51.
    Article CAS Google Scholar
  8. Imai K, Takai K, Hanai T, et al. Skeletal muscle depletion predicts the prognosis of patients with hepatocellular carcinoma treated with sorafenib. Int J Mol Sci. 2015;15:9612–24.
    Article Google Scholar
  9. Lee J, Cho Y, Park S, et al. Skeletal muscle depletion predicts the prognosis of patients with hepatocellular carcinoma treated with radiotherapy. Front Oncol. 2019;9:1075.
    Article CAS Google Scholar
  10. Harimoto N, Shirabe K, Yamashita YI, et al. Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013;100:1523–30.
    Article CAS Google Scholar
  11. Levolger S, Van Vledder MG, Muslem R, et al. Sarcopenia impairs survival in patients with potentially curable hepatocellular carcinoma. J Surg Oncol. 2015;112:208–13.
    Article Google Scholar
  12. Kaido T, Ogawa K, Fujimoto Y, et al. Impact of sarcopenia on survival in patients undergoing living donor transplantation. Am J Transp. 2013;13:1549–56.
    Article CAS Google Scholar
  13. Englesbe MJ, Patel SP, He K, et al. Sarcopenia and mortality after liver transplantation. J Am Coll Surg. 2010;211:271–8.
    Article Google Scholar
  14. Dodson RM, Firoozmand A, Hyder O, et al. Impact of sarcopenia on outcomes following intra-arterial therapy of hepatic malignancies. J Gastrointest Surg. 2013;17:2123–32.
    Article Google Scholar
  15. Kobayashi T, Kawai H, Nakano O, et al. Rapidly declining skeletal muscle mass predicts poor prognosis of hepatocellular carcinoma treated with transcatheter intra-arterial therapies. BMC Cancer. 2018;18:756.
    Article Google Scholar
  16. Lanza E, Masetti C, Messana G, et al. Sarcopenia as a predictor of survival in patients undergoing bland transarterial embolization for unresectable hepatocellular carcinoma. PLoS ONE. 2020;15:e0232371.
    Article CAS Google Scholar
  17. Faron A, Sprinkart AM, Pieper CC, et al. Yttrium-90 radioembolization for hepatocellular carcinoma: outcome prediction with MRI derived fat-free muscle area. Eur Radiol. 2020. https://doi.org/10.1016/j.ejrad.2020.108889.
    Article PubMed PubMed Central Google Scholar
  18. Lee YJ, Lee JM, Lee JS, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging: a systematic review and meta-analysis. Radiology. 2015;275:97–109.
    Article Google Scholar
  19. Praktiknjo M, Book M, Luetkiens J, et al. Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis. Hepatology. 2018;67:1014–26.
    Article CAS Google Scholar
  20. Janssen I. Evolution of sarcopenia research. Appl Physiol Nutr Metab. 2010;35:707–12.
    Article Google Scholar
  21. Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci. 2006;61:1059–64.
    Article Google Scholar
  22. Fearon KC, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.
    Article Google Scholar
  23. Fearon KC. Cancer cachexia and fat-muscle physiology. N Engl J Med. 2011;365:565–7.
    Article CAS Google Scholar
  24. Mondazzi L, Botteli R, Brambilla G, et al. Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma: a multivariate analysis of prognostic factors. Hepatology. 1994;19:1115–23.
    Article CAS Google Scholar
  25. Goin JE, Salem R, Carr BI, et al. Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: a risk-stratification analysis. J Vasc Interv Radiol. 2005;16:195–203.
    Article Google Scholar
  26. Lewandowski RJ, Mulcahy MF, Kulik LM, et al. Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort. Radiology. 2010;255:955–65.
    Article Google Scholar
  27. Hu HT, Kim JH, Lee LS, et al. Chemoembolization for hepatocellular carcinoma: a multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort. J Vasc Interv Radiol. 2011;22(917):923.
    Google Scholar
  28. European association for the study of the liver; European organization for research and treatment of cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012; 56: 908–943.
  29. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach: the ALBI grade. J Clin Oncol. 2015;33:550–8.
    Article Google Scholar
  30. Hickey R, Mouli S, Kulik L, et al. Independent analysis of albumin-bilirubin grade in a 765-patient cohort treated with transarterial locoregional therapy for hepatocellular carcinoma. J Vasc Interv Radiol. 2016;27:795–802.
    Article Google Scholar
  31. Cruz RJ, Dew MA, Myaskovsky L, et al. Objective radiologic assessment of body composition in patients with end-stage liver disease: going beyond the BMI. Transplantation. 2013;95:617–22.
    Article Google Scholar

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Funding

The authors did not receive any support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY, 10016, USA
    Phillip L. Guichet, Bedros Taslakian, Chenyang Zhan, Sean Farquharson, Ryan Hickey, Cash J. Horn & Jonathan S. Gross
  2. Department of Radiology, Denver Health, 777 Bannock St., Pavilion A, Denver, CO, 80204, USA
    Eric Aaltonen

Authors

  1. Phillip L. Guichet
  2. Bedros Taslakian
  3. Chenyang Zhan
  4. Eric Aaltonen
  5. Sean Farquharson
  6. Ryan Hickey
  7. Cash J. Horn
  8. Jonathan S. Gross

Corresponding author

Correspondence toPhillip L. Guichet.

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Conflict of interest

Author Ryan Hickey is a consultant for and has received a speaking fee from Boston Scientific. The remaining authors have no financial or non-financial interests to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required. This article does not contain any studies with animals performed by any of the authors. This single-center, retrospective cohort study was approved by the local Institutional Review Board.

This study has obtained IRB approval from the Institutional Review Board of New York University Grossman School of Medicine and the need for informed consent was waived.

For this type of study consent for publication is not required.

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Guichet, P.L., Taslakian, B., Zhan, C. et al. MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma.Cardiovasc Intervent Radiol 44, 1561–1569 (2021). https://doi.org/10.1007/s00270-021-02874-6

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