Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma.
Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma.
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DOI：
10.1007/s00261-020-02751-9
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Kaseb AO
中科院分区：
文献类型：
--
作者：
Qayyum A;Bhosale P;Aslam R;Avritscher R;Ma J;Pagel MD;Sun J;Mohamed Y;Rashid A;Beretta L;Kaseb AO
肌肉减少症是肝细胞癌（HCC）的独立预后指标。我们的目的是确定肌肉减少症对晚期肝癌患者全身靶向治疗反应的影响。这是一项回顾性的、机构审查委员会批准的研究，纳入了36例接受免疫检查点阻断（n = 25）或酪氨酸激酶抑制剂（n = 11）全身靶向治疗的活检证实的晚期HCC患者。根据治疗前CT上T12水平的竖脊肌面积（SMA）计算骨骼肌指数（SMI）：[SMI = SMA（cm 2）/身高（m2）]。将SMI与治疗反应进行比较，治疗反应定义为总生存期≥ 1年（非手术患者）或> 50% HCC坏死（手术患者）。使用受试者工作特征曲线和曲线下面积进行分析，p < 0.05具有统计学意义。男性和女性的中位年龄分别为66.5岁（范围32-83岁）和70岁（范围54-78岁）。肝病病因为非酒精性脂肪性肝炎（n = 9）、丙型肝炎（n = 10）、B肝炎（n = 5）、酒精（n = 3）和未知（n = 9）。男性的平均（± SD）身高和SMI分别为1.7 m（± 0.1）和11.4（± 3.6）;女性分别为1.7 m（± 0.1）和8.2（± 1.9）。5例患者因治疗不耐受而停止治疗。10/31例（32.3%）患者（23例男性，8例女性）出现缓解。T12 SMI与治疗反应相关，女性阈值为7.21-8.23（AUC = 1; p = 0.037），男性阈值为11.47（AUC = 0.83; p = 0.015）; ≥ 60岁男性的相关性增加（AUC = 0.87; p = 0.023）。在接受全身靶向治疗的患者中，肌肉减少症与生存率降低和HCC坏死相关。肌肉减少症可能有助于预测晚期HCC靶向治疗的结果。
Sarcopenia is an independent prognostic indicator for hepatocellular carcinoma (HCC). Our objective was to determine the effect of sarcopenia on response to systemic targeted therapy in patients with advanced HCC. This was a retrospective, Institutional Review Board approved study of 36 patients on systemic targeted therapy with immune checkpoint blockade (n = 25) or tyrosine kinase inhibitor (n = 11) for biopsy-proven advanced HCC. Skeletal muscle index (SMI) was calculated from erector spinae muscle area (SMA) at the level of T12 on pretreatment CT: [SMI = SMA (cm2)/height (m2)]. SMI was compared to treatment response defined as overall survival ≥ 1 year (nonsurgical patients) or > 50% HCC necrosis (surgical patients). Receiver operating characteristic curve and area under the curve was used for analysis with p < 0.05 for statistical significance. Median age of men and women was 66.5 years (range 32–83) and 70 years (range 54–78), respectively. Liver disease etiology was nonalcoholic steatohepatitis (n = 9), hepatitis C (n = 10), hepatitis B (n = 5), alcohol (n = 3) and unknown (n = 9). Mean (± SD) height and SMI for men were 1.7 m (± 0.1) and 11.4 (± 3.6); values for women were 1.7 m (± 0.1) and 8.2 (± 1.9). Treatment was withdrawn in five patients due to treatment intolerance. Response occurred in 10/31 (32.3%) patients (23 men, 8 women). T12SMI correlated with treatment response using a threshold of 7.21-8.23 for women (AUC = 1; p = 0.037), and 11.47 for men (AUC = 0.83; p = 0.015); correlation was increased for men ≥ 60 years, (AUC = 0.87; p = 0.023). Sarcopenia was associated with reduced survival and HCC necrosis in patients treated with systemic targeted therapy. Sarcopenia may help in predicting outcomes to targeted therapy in advanced HCC.
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