Keywords: Skeletal muscle index, Hepatocellular carcinoma, Curative hepatectomy, Adjuvant transarterial chemoembolization, Prognosis
Abstract
Background
To evaluate the prognostic value of skeletal muscle index (SMI) and its change in patients with
hepatocellular carcinoma (HCC) experiencing curative hepatectomy plus adjuvant transarterial chemoembolization (TACE).
Methods
A total of 62 patients with HCC who underwent adjuvant TACE after curative hepatectomy were analysed retrospectively. Skeletal muscle area at the third lumbar level was quantitated using computed tomography images and was normalized for height squared to obtain skeletal muscle index (SMI). Skeletal muscle loss (SML) over six months was computed with two SMIs before and after hepatectomy plus adjuvant TACE.
Correlation analyses were preformed to investigate factors associated with SML. The curves of cause-specific survival (CSS) were analysed using the Kaplan-Meier method. A Cox proportional hazards model was used to assess prognostic factors.
Results
Low SMI was diagnosed in 23(37.1%) patients preoperatively. The median SML standardized by 6 months was -1.6% in the entire cohort. Liver cirrhosis and microvascular invasion correlated negatively with SML respectively (r=-0.320, P=0.002; r=-0.243, P=0.021). Higher SML (<-2.42%) predicted a significant reduction in CSS (P=0.001), whereas low SMI did not(P=0.687). Following the multivariate analysis for CSS, AFP> 400 ng/ml (HR, 5.643; 95%CI, 3.608-17.833; P<0.001) and SML<-2.42% (HR, 6.586; 95%CI, 3.610-22.210; P<0.001) were independent predictors for poor CSS.
Conclusions
Skeletal muscle loss during hepatectomy plus adjuvant TACE was remarkable. Higher SML was an
independent risk factor for CSS in patients with HCC, especially those with liver cirrhosis.