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Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

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.

Materials and methods

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.

Results

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 Treatment was withdrawn in five patients due to treatment intolerance.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).

Conclusion

Sarcopenia was associated with reduced survival and HCC necrosis in patients treated with systemic targeted therapy.

Clinical relevance

Sarcopenia may help in predicting outcomes to targeted therapy in advanced HCC.

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Abbreviations

HCC:

Hepatocellular carcinoma

ICB:

Immune checkpoint blockade

MDSCs:

Myeloid-derived suppressor cells

NK:

Natural killer

PD-1:

Programmed cell death protein 1

RECIST:

Response evaluation criteria in solid tumors

SMA:

Skeletal muscle area

SMI:

Skeletal Muscle Index

TKI:

Tyrosine kinase inhibitor

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Funding

Supported by the MD Anderson Cancer Center SPORE in Hepatocellular Carcinoma Grant P50 CA217674 and by the NIH/NCI under Award Number P30CA016672.

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Authors and Affiliations

  1. Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Unit 1473, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Aliya Qayyum, Priya Bhosale & Rizwan Aslam

  2. Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Rony Avritscher

  3. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Jingfei Ma

  4. Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Mark D. Pagel

  5. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Jia Sun

  6. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Yehia Mohamed & Ahmed O. Kaseb

  7. Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Asif Rashid

  8. Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Laura Beretta

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  1. Aliya Qayyum
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  11. Ahmed O. Kaseb
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Correspondence to Aliya Qayyum.

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Qayyum, A., Bhosale, P., Aslam, R. et al. Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma. Abdom Radiol 46, 1008–1015 (2021). https://doi.org/10.1007/s00261-020-02751-9

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  • DOI: https://doi.org/10.1007/s00261-020-02751-9

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