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Sarcopenia and myosteatosis are associated with survival in patients receiving immunotherapy for advanced hepatocellular carcinoma

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To investigate the association of sarcopenia, myosteatosis, and sarcopenic obesity with survival outcomes among patients who underwent immunotherapy for advanced hepatocellular carcinoma (HCC).

Methods

In this retrospective analysis, patients who initiated immunotherapy for advanced HCC were enrolled. Sarcopenia and myosteatosis were evaluated on pretreatment CT at L3 level by skeletal muscle index and mean muscle attenuation using predefined cutoff values. Sarcopenic obesity was defined as concurrent sarcopenia and body mass index > 25 kg/m2. The log-rank test and the Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS).

Results

A total of 138 patients was included (discovery cohort n = 111, validation cohort n = 27). In the discovery cohort, patients with sarcopenia exhibited significantly poorer PFS (p = 0.048) and OS (p = 0.002) than patients without sarcopenia. Patients with myosteatosis exhibited significantly poorer PFS (p < 0.001) and OS (p < 0.001) than patients without myosteatosis. Patients with sarcopenic obesity compared to patients without sarcopenic obesity exhibited significantly poorer OS (p = 0.006) but not PFS (p = 0.31). In multivariate analysis adjusting for patient demographics, tumor extent, and liver function reserve, myosteatosis remained an independent predictor of poor PFS (p = 0.014) and OS (p = 0.007); sarcopenia remained an independent predictor for poor OS (p = 0.007). The prediction models for survival outcomes built by the discovery cohort showed similar performance in the validation cohort.

Conclusions

Sarcopenia and myosteatosis are independent prognostic factors in patients who received immunotherapy for advanced HCC.

Key Points

• Sarcopenia and myosteatosis can be evaluated by CT at L3 level.

• Sarcopenia, myosteatosis, and sarcopenic obesity were associated with poor survival outcomes in patients who underwent immunotherapy for advanced HCC.

• Myosteatosis was an independent predictor of PFS and OS, and sarcopenia was independent for OS in these patients.

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Abbreviations

BCLC:

Barcelona Clinic Liver Cancer

BMI:

Body mass index

CT:

Computed tomography

CTLA-4:

Cytotoxic T-lymphocyte-associated protein 4

HCC:

Hepatocellular carcinoma

HU:

Hounsfield units

ICI:

Immune checkpoint inhibitor

OS:

Overall survival

PD-1:

Programmed cell death protein 1

PFS:

Progression-free survival

RECIST:

Response Evaluation Criteria in Solid Tumors

SMD:

Skeletal muscle density

SMI:

Skeletal muscle index

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Funding

This study has received funding from the Ministry of Science and Technology, Taiwan (MOST-103-2314-B-002-181-MY2, MOST-105-2314-B-002-194, MOST-106-2314-B-002-213, MOST-108-2314-B-002-072-MY3, MOST-110-2314-B-002-144, and MOST-111-2314-B-002-120); the Ministry of Health and Welfare, Taiwan (MOHW109-TDU-B-211-114002); the National Taiwan University Hospital (NTUH 105S2954, and NTUH 108-S4150); and the Good Liver Foundation, Taiwan.

Author information

Authors and Affiliations

  1. Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan

    Bang-Bin Chen, Po-Chin Liang & Tiffany Ting-Fang Shih

  2. Department of Radiology, College of Medicine, National Taiwan University, Taipei City, Taiwan

    Bang-Bin Chen, Po-Chin Liang & Tiffany Ting-Fang Shih

  3. Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, 300, Taiwan

    Po-Chin Liang

  4. Department of Oncology, National Taiwan University Hospital, No 7, Chung-Shan South Rd, Taipei City, 100, Taiwan

    Tsung-Hao Liu, Ying-Chun Shen, Li-Chun Lu, Zhong-Zhe Lin, Chiun Hsu, Chih-Hung Hsu, Ann-Lii Cheng & Yu-Yun Shao

  5. Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan

    Tsung-Hao Liu, Ying-Chun Shen, Li-Chun Lu, Chiun Hsu, Chih-Hung Hsu, Ann-Lii Cheng & Yu-Yun Shao

  6. Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan

    Tsung-Hao Liu, Ying-Chun Shen, Li-Chun Lu, Zhong-Zhe Lin, Chiun Hsu, Chih-Hung Hsu, Ann-Lii Cheng & Yu-Yun Shao

  7. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Ann-Lii Cheng

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  1. Bang-Bin Chen
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Corresponding author

Correspondence to Yu-Yun Shao.

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Guarantor

The scientific guarantor of this publication is Yu-Yun Shao, MD, Ph.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Bang-Bin Chen, MD. has significant statistical expertise. The authors would like to express their thanks to the staff of the National Taiwan University Hospital-Statistical Consulting Unit (NTUH-SCU) for statistical consultation and analyses.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained from National Taiwan University Hospital.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Chen, BB., Liang, PC., Shih, T.TF. et al. Sarcopenia and myosteatosis are associated with survival in patients receiving immunotherapy for advanced hepatocellular carcinoma. Eur Radiol 33, 512–522 (2023). https://doi.org/10.1007/s00330-022-08980-4

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  • DOI: https://doi.org/10.1007/s00330-022-08980-4

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