Introduction
The prognosis for patients with hepatocellular carcinoma (HCC) remains extremely poor, with a 5-year survival rate of 20% without curative treatment. A recent studyi demonstrated that the use of a computed CT score including muscle density and muscle area could identify frailty in cirrhotic patients and predict 6-month mortality. The objective of the study was to evaluate predictors of 6-month mortality in patients with HCC and to establish the impact of sarcopenia in this context.
Aims & Methods
We performed a retrospective analysis of 86 patients with HCC treated at the Hôtel Dieu de France in Beirut between 2016 and 2024. The collection included clinical and biological data, prognostic indices (Child Pugh scores, MELD) as well as CT parameters for measuring sarcopenia and myosteatosis, including skeletal muscle index, muscle densities, and muscle surfaces at L3 level. The coreslicer® software was used to calculate muscle and fat surfaces on CT. The measurements evaluated included the surfaces at L3 of the psoas and paravertebral and parietal muscles, as well as the density of the psoas. Among these, the “L3 skeletal muscle area adjusted to height and density ratio (L3- SMHDR)” which is calculated by the total muscle area at the L3 level * Average size / density of the psoas muscles at the L3 level. This measurement helps include myosteatosis in the assessment of sarcopenia.
Results
- Our population included 86 patients with HCC, 74 men, 12 women, with a mean age of 66.1 ± 10.7 years. MELD-Na score was 16.1 ± 8.2, and Child-Pugh score was A, B, and C in 39%, 27%, and 34%, respectively. Twelve patients (14%) were eligible for curative treatment, in accordance with BCLC guidelines.
- Decreased survival is significantly associated with increasing L3-SMHDR. An AUROC analysis for L3-SMHDR as a predictor of mortality at 1 month found the same cutoff values as a previously published study with cutoffs of 5.4 and 4.7 in men and women, respectively. Populations with low L3-SMHDR vs. high L3-SMHDR had a survival time of 31.2 months vs. 11.09 months (P=0.035).
- In order to determine the different factors linked to a decrease in survival at 6 months, we conducted a univariate analysis which identified the following parameters: muscle density at scan (p=0.016), L3-SMHDR (p=0.004), L3-DRMI (p=0.034) and the MELD-Na score (P=0.077). A value of L3-SMHDR > threshold had a risk of mortality OR= 7.8 [1.8-34, P=0.003] and 5.64 [1.3-23.8, P=0.013] at 6 and 12 months respectively.
- In multivariate analysis, the two independent prognostic factors were the MELD-Na score and L3-SMHDR, which allowed us to arrive at the following equation:
- Probability = 0.112* MELDNa + 2.518* L3-SMHDR – 3.11.
- This analysis allowed us to classify patients according to the above function categories, and to estimate the risk of mortality at 6 and 12 months at respectively OR = 10 [2-50, P=0.003] and 11.4 [2.2-58.6, P=0.002].
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Conclusion
The 6-month prognosis of patients with HCC depends primarily on liver function and the severity of sarcopenia and myosteatosis, not tumor stage. This should provide additional prioritization for patients eligible for liver transplantation. Confirmation of these results should be considered in a larger-scale study.
References
i. El Khoueiry C, Slim R, Rida M, Khoury B, Honein K, Smayra T, Yaghi C. New Scanographic Index for the Detection of Frailty in Patients with Cirrhosis with a Prognostic Impact. Middle East J Dig Dis. 2024 Apr;16(2):102-108. doi: 10.34172/mejdd.2024.376. Epub 2024 Apr 30. PMID: 39131107; PMCID: PMC11316193.