Prevalence and role of low skeletal muscle mass (LSMM) in hepatocellular carcinoma. A systematic review and meta-analysis.
Cachexia
Hepatocellular carcinoma
Muscle depletion
Overall survival
Skeletal muscle index
Journal
Clinical nutrition ESPEN
ISSN: 2405-4577
Titre abrégé: Clin Nutr ESPEN
Pays: England
ID NLM: 101654592
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
20
01
2022
revised:
17
03
2022
accepted:
06
04
2022
entrez:
27
5
2022
pubmed:
28
5
2022
medline:
1
6
2022
Statut:
ppublish
Résumé
Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor disease in the world. The impact of sarcopenia on survival outcomes in patients with HCC has been studied, but the extent of the impact remains unclear. This systematic review and meta-analysis aimed to analyze the prevalence of low skeletal muscle mass (LSMM) as a surrogate parameter for sarcopenia in patients with HCC and its influence on survival parameters after various treatments in a large study population. Different databases such as MEDLINE, Cochrane database, and SCOPUS were screened for studies on sarcopenia, respectively LSMM and survival in HCC up to March 2021. Twenty-seven studies met the inclusion criteria. The methodological quality was analyzed via QUADAS-2. We investigated the prevalence of LSMM and its impact on overall and recurrence/disease-free survival. The prevalence of LSMM, defined by different cut-off values, was 38.5%. In patients with LSMM, overall survival (OS) was strongly impaired in univariable and multivariable analyses: HR = 1.84, 95% CI = 1.64-2.07, p < 0.00001 and HR = 1.89, 95% CI = 1.61-2.23, p < 0.00001, respectively. Subanalyses on patients treated with kinase inhibitors such as Sorafenib or Lenvatinib (4 studies) or hepatectomy (6 studies) showed lower overall survival in multivariable regression with HR = 2.24, 95% = 1.60-3.14, p < 0.00001 and HR = 2.17, 95% CI = 1.48-3.19, p < 0.00001, respectively. Patients with LSMM post-resection also showed lower recurrence-free survival with HR = 1.79, 95% CI = 1.28-2.50, p < 0.00001 in multivariable analysis. LSMM is very frequent in patients with HCC. Due to its impact on survival, there is a need for adequate treatment and prevention, which proves to be challenging due to its multifactorial nature. For future investigation, one should focus on prospective study protocols as well as standardized assessment methods and cut-off values.
Sections du résumé
BACKGROUND & AIMS
Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor disease in the world. The impact of sarcopenia on survival outcomes in patients with HCC has been studied, but the extent of the impact remains unclear. This systematic review and meta-analysis aimed to analyze the prevalence of low skeletal muscle mass (LSMM) as a surrogate parameter for sarcopenia in patients with HCC and its influence on survival parameters after various treatments in a large study population.
METHODS
Different databases such as MEDLINE, Cochrane database, and SCOPUS were screened for studies on sarcopenia, respectively LSMM and survival in HCC up to March 2021. Twenty-seven studies met the inclusion criteria. The methodological quality was analyzed via QUADAS-2. We investigated the prevalence of LSMM and its impact on overall and recurrence/disease-free survival.
RESULTS
The prevalence of LSMM, defined by different cut-off values, was 38.5%. In patients with LSMM, overall survival (OS) was strongly impaired in univariable and multivariable analyses: HR = 1.84, 95% CI = 1.64-2.07, p < 0.00001 and HR = 1.89, 95% CI = 1.61-2.23, p < 0.00001, respectively. Subanalyses on patients treated with kinase inhibitors such as Sorafenib or Lenvatinib (4 studies) or hepatectomy (6 studies) showed lower overall survival in multivariable regression with HR = 2.24, 95% = 1.60-3.14, p < 0.00001 and HR = 2.17, 95% CI = 1.48-3.19, p < 0.00001, respectively. Patients with LSMM post-resection also showed lower recurrence-free survival with HR = 1.79, 95% CI = 1.28-2.50, p < 0.00001 in multivariable analysis.
CONCLUSION
LSMM is very frequent in patients with HCC. Due to its impact on survival, there is a need for adequate treatment and prevention, which proves to be challenging due to its multifactorial nature. For future investigation, one should focus on prospective study protocols as well as standardized assessment methods and cut-off values.
Identifiants
pubmed: 35623801
pii: S2405-4577(22)00234-0
doi: 10.1016/j.clnesp.2022.04.009
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-113Informations de copyright
Copyright © 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare, that they have no conflict of interest.