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Impact of Sarcopenia on Outcomes Following Intra-arterial Therapy of Hepatic Malignancies

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Assessment of patient performance status is often subjective. Sarcopenia—measurement of muscle wasting—may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT).

Methods

Total psoas area (TPA) was measured on cross-sectional imaging in 216 patients undergoing IAT of hepatic malignancies between 2002 and 2012. Sarcopenia was defined as TPA in the lowest sex-specific quartile. Impact of sarcopenia was assessed relative to other clinicopathological factors.

Results

Indications for IAT included hepatocellular carcinoma (51 %), intrahepatic cholangiocarcinoma (13 %), colorectal liver metastasis (7 %), or other metastatic disease (30 %). Median TPA among men (568 mm2/m2) was greater than women (413 mm2/m2). IAT involved conventional chemoembolization (54 %), drug-eluting beads (40 %), or yttrium-90 (6 %). Median tumor size was 5.8 cm; most patients had multiple lesions (74 %). Ninety-day mortality was 9.3 %; 3-year survival was 39 %. Factors associated with risk of death were tumor size (HR = 1.84) and Child's score (HR = 2.15) (all P < 0.05). On multivariate analysis, sarcopenia remained independently associated with increased risk of death (lowest vs. highest TPA quartile, HR = 1.84; P = 0.04). Sarcopenic patients had a 3-year survival of 28 vs. 44 % for non-sarcopenic patients.

Conclusions

Sarcopenia was an independent predictor of mortality following IAT with sarcopenic patients having a twofold increased risk of death. Sarcopenia is an objective measure of frailty that can help clinical decision-making regarding IAT for hepatic malignancies.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600 N. Wolfe Street, Baltimore, 21287, MD, USA

    Rebecca M. Dodson, Amin Firoozmand, Omar Hyder, Christopher L. Wolfgang & Timothy M. Pawlik

  2. Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Vania Tacher, Nikhil Bhagat, Jean-Francois H. Geschwind & Ihab R. Kamel

  3. Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    David P. Cosgrove

  4. Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Joseph M. Herman

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  1. Rebecca M. Dodson
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Correspondence to Timothy M. Pawlik.

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Dodson, R.M., Firoozmand, A., Hyder, O. et al. Impact of Sarcopenia on Outcomes Following Intra-arterial Therapy of Hepatic Malignancies. J Gastrointest Surg 17, 2123–2132 (2013). https://doi.org/10.1007/s11605-013-2348-5

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