Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
29
05
2020
accepted:
03
08
2020
pubmed:
24
9
2020
medline:
11
3
2021
entrez:
23
9
2020
Statut:
ppublish
Résumé
The aim of this study was to assess the prognostic value of liver surface nodularity (LSN) and sarcopenia from preoperative computed tomography (CT) in patients with resectable metabolic syndrome (MS)-related hepatocellular carcinoma (HCC). Patients with MS undergoing hepatectomy for HCC between 2006 and 2018 at a single center were retrospectively analyzed. LSN and sarcopenia were assessed on preoperative CT scans, and their association with severe (Clavien-Dindo grade 3-5) postoperative complications was analyzed on multivariate analysis. The influence of LSN and sarcopenia on overall survival (OS) and recurrence-free survival (RFS) was assessed. Overall, 110 patients (92 men [84%], mean 67.7 ± 7.7 years of age) were analyzed. Severe postoperative complications occurred in 34/110 (31%) patients. Patients with severe complications had a significantly higher LSN score (area under the receiver operating characteristic curve 0.68 ± 0.05, optimal cut-off > 2.50) and were more frequently sarcopenic (47% vs. 13% without major complications, p < 0.001). Multivariate analysis identified sarcopenia (odds ratio [OR] 6.51, 95% confidence interval [CI] 2.08-20.39; p < 0.001), LSN > 2.50 (OR 7.05, 95% CI 2.13-23.35; p < 0.001), and preoperative portal vein embolization (PVE; OR 6.06, 95% CI 1.71-21.48; p = 0.005) as independent predictors of severe complications. LSN and sarcopenia had no influence on OS. Stratification according to a combination of LSN > 2.50 and sarcopenia predicted the risk of severe postoperative complications from 7% (no sarcopenia and LSN ≤2.50) to 71% (sarcopenia and LSN > 2.50; p < 0.001), as well as RFS from 61 months (95% CI 40-82) to 17 months (95% CI 9-25; p = 0.033). Results remained significant in 52 patients without advanced fibrosis. The combination of LSN and sarcopenia derived from routine preoperative CT seems to help predict severe postoperative complications and stratification of RFS in patients with MS and resectable HCC.
Identifiants
pubmed: 32965614
doi: 10.1245/s10434-020-09143-9
pii: 10.1245/s10434-020-09143-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
405-416Références
Scuteri A, Laurent S, Cucca F, et al. Metabolic syndrome across Europe: different clusters of risk factors. Eur J Prev Cardiol. 2015;22(4):486–91. https://doi.org/10.1177/2047487314525529 .
doi: 10.1177/2047487314525529
pubmed: 24647805
Cauchy F, Zalinski S, Dokmak S, et al. Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome. Br J Surg. 2013;100(1):113–21. https://doi.org/10.1002/bjs.8963 .
doi: 10.1002/bjs.8963
pubmed: 23147992
Kim HS, El-Serag HB. The epidemiology of hepatocellular carcinoma in the USA. Curr Gastroenterol Rep. 2019;21(4):17. https://doi.org/10.1007/s11894-019-0681-x .
doi: 10.1007/s11894-019-0681-x
pubmed: 30976932
Estes C, Anstee QM, Arias-Loste MT, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016–2030. J Hepatol. 2018;69(4):896–904. https://doi.org/10.1016/j.jhep.2018.05.036 .
doi: 10.1016/j.jhep.2018.05.036
pubmed: 29886156
Reddy SK, Marsh JW, Varley PR, et al. Underlying steatohepatitis, but not simple hepatic steatosis, increases morbidity after liver resection: a case-control study. Hepatology. 2012;56(6):2221–30. https://doi.org/10.1002/hep.25935 .
doi: 10.1002/hep.25935
pubmed: 22767263
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 Ageing. 2010;39(4):412–23. https://doi.org/10.1093/ageing/afq034 .
doi: 10.1093/ageing/afq034
pubmed: 20392703
pmcid: 20392703
Zhang H, Lin S, Gao T, et al. Association between sarcopenia and metabolic syndrome in middle-aged and older non-obese adults: a systematic review and meta-analysis. Nutrients. 2018;10(3):pii:E364. https://doi.org/10.3390/nu10030364 .
doi: 10.3390/nu10030364
Mitchell WK, Williams J, Atherton P, et al. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength: a quantitative review. Front Physiol. 2012;3:260. https://doi.org/10.3389/fphys.2012.00260 .
doi: 10.3389/fphys.2012.00260
pubmed: 22934016
pmcid: 3429036
Hamaguchi Y, Kaido T, Okumura S, et al. Muscle steatosis is an independent predictor of postoperative complications in patients with hepatocellular carcinoma. World J Surg. 2016;40(8):1959–68. https://doi.org/10.1007/s00268-016-3504-3 .
doi: 10.1007/s00268-016-3504-3
pubmed: 27071610
Kobayashi A, Kaido T, Hamaguchi Y, et al. Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg. 2019;269(5):924–31. https://doi.org/10.1097/sla.0000000000002555 .
doi: 10.1097/SLA.0000000000002555
pubmed: 29064889
Smith AD, Zand KA, Florez E, et al. Liver surface nodularity score allows prediction of cirrhosis decompensation and death. Radiology. 2017;283(3):711–722. https://doi.org/10.1148/radiol.2016160799 .
doi: 10.1148/radiol.2016160799
pubmed: 27809664
Sartoris R, Rautou PE, Elkrief L, et al. Quantification of liver surface nodularity at CT: utility for detection of portal hypertension. Radiology. 2018;289(3):698–707. https://doi.org/10.1148/radiol.2018181131 .
doi: 10.1148/radiol.2018181131
pubmed: 30179109
Hobeika C, Cauchy F, Sartoris R, et al. Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma. Br J Surg. 2020;107(7):878–88. https://doi.org/10.1002/bjs.11511 .
doi: 10.1002/bjs.11511
pubmed: 32118298
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106(25):3143–421.
Galle PR, Forner A, Llovet JM, et al. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236. https://doi.org/10.1016/j.jhep.2018.03.019 .
doi: 10.1016/j.jhep.2018.03.019
Coinaud C. Liver lobes and segments: notes on the anatomical architecture and surgery of the liver. Presse Med. 1954;62(33):709–12.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41(6):1313–21.
doi: 10.1002/hep.20701
Bedossa P, FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology. 2014;60(2):565–75. https://doi.org/10.1002/hep.27173 .
doi: 10.1002/hep.27173
pubmed: 24753132
Sartoris R, Lazareth M, Nivolli A, et al. CT-based liver surface nodularity for the detection of clinically significant portal hypertension: defining measurement quality criteria. Abdom Radiol (NY). 2020;45(9):2755–63. https://doi.org/10.1007/s00261-020-02519-1 .
doi: 10.1007/s00261-020-02519-1
Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35. https://doi.org/10.1016/s1470-2045(08)70153-0 .
doi: 10.1016/S1470-2045(08)70153-0
Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. 2015;261(6):1173–83. https://doi.org/10.1097/sla.0000000000000743 .
doi: 10.1097/SLA.0000000000000743
pubmed: 24950264
Zhang G, Meng S, Li R, Ye J, Zhao L. Clinical significance of sarcopenia in the treatment of patients with primary hepatic malignancies, a systematic review and meta-analysis. Oncotarget. 2017;8(60):102474–85. https://doi.org/10.18632/oncotarget.19687 .
doi: 10.18632/oncotarget.19687
pubmed: 29254263
pmcid: 5731973
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(11):1523–30. https://doi.org/10.1002/bjs.9258 .
doi: 10.1002/bjs.9258
pubmed: 24037576
Fujiwara N, Nakagawa H, Kudo Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63(1):131–40. https://doi.org/10.1016/j.jhep.2015.02.031 .
doi: 10.1016/j.jhep.2015.02.031
pubmed: 25724366
Chang KV, Chen JD, Wu WT. Association between loss of skeletal muscle mass and mortality and tumor recurrence in hepatocellular carcinoma: a systematic review and meta-analysis. Liver Cancer. 2018;7(1):90–103. https://doi.org/10.1159/000484950 .
doi: 10.1159/000484950
pubmed: 29662836
Lo GC, Besa C, King MJ, et al. Feasibility and reproducibility of liver surface nodularity quantification for the assessment of liver cirrhosis using CT and MRI. Eur J Radiol Open. 2017;4:95–100. https://doi.org/10.1016/j.ejro.2017.07.001 .
doi: 10.1016/j.ejro.2017.07.001
pubmed: 28761907
pmcid: 5524318
De Vos N, Sartoris R, Cauchy F, et al. Performance of liver surface nodularity quantification for the diagnosis of portal hypertension in patients with cirrhosis: comparison between MRI with hepatobiliary phase sequences and CT. Abdom Radiol (NY). 2020;45(2):365–72. https://doi.org/10.1007/s00261-019-02355-y .
doi: 10.1007/s00261-019-02355-y
pubmed: 31797023