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Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

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).

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France

    Martin Seror MD, Riccardo Sartoris MD, Valérie Vilgrain MD, PhD & Maxime Ronot MD, PhD

  2. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France

    Christian Hobeika MD, Olivier Soubrane MD, PhD & François Cauchy MD

  3. Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France

    Mohamed Bouattour MD & Pierre-Emmanuel Rautou MD, PhD

  4. Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France

    Valérie Paradis MD, PhD

  5. Université de Paris, Centre de recherche sur l’inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France

    Riccardo Sartoris MD, Valérie Paradis MD, PhD, Pierre-Emmanuel Rautou MD, PhD, Valérie Vilgrain MD, PhD, François Cauchy MD & Maxime Ronot MD, PhD

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  1. Martin Seror MD
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Correspondence to Maxime Ronot MD, PhD.

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Martin Seror, Riccardo Sartoris, Christian Hobeika, Mohamed Bouattour, Valérie Paradis, Pierre-Emmanuel Rautou, Olivier Soubrane, Valérie Vilgrain, François Cauchy, and Maxime Ronot have no conflicts of interest to declare.

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Seror, M., Sartoris, R., Hobeika, C. et al. Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma. Ann Surg Oncol 28, 405–416 (2021). https://doi.org/10.1245/s10434-020-09143-9

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