Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments
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REVIEW
Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments Giovanni Marasco1 • Matteo Serenari1 • Matteo Renzulli2 • Luigina Vanessa Alemanni1 • Benedetta Rossini1 • Irene Pettinari2 • Elton Dajti1 • Federico Ravaioli1 • Rita Golfieri2 • Matteo Cescon1 • Davide Festi1 • Antonio Colecchia3
Received: 11 June 2020 / Accepted: 15 July 2020 Ó The Author(s) 2020
Abstract Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients’ survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed. & Giovanni Marasco [email protected] 1
Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40126 Bologna, Italy
2
Radiology Unit, Sant’Orsola Malpighi Hospital, Via Albertoni 4, 40138 Bologna, Italy
3
Gastroenterology Unit, University Hospital Borgo Trento, Verona, Italy
Keywords Sarcopenia Hepatocellular carcinoma Liver resection Sorafenib Abbreviations HCC Hepatocellular carcinoma BCLC Barcelona clinic liver cancer ECOG Eastern cooperative group OS Overall survival ICGRIndocyanine green retention test at 15 min 15 BMI Body mass index SMI Skeletal muscle index HR Hazard ratio CI Confidence interval TFLV Total functional liver volume TPA Total psoas area ISGLS International study group of liver surgery grading OR Odds ratio PHLF Post hepatectomy liver failure RFA Radiofrequency ablation PMI Psoas muscle index CT Computed tomography scan ROC Receiver operating characteristics AUROC Area under receiver operating characteristics curve ESLD End-stage liver disease LT Liver transplantation TMPT Transverse psoas muscle thickness MELD Model for end-stage liver disease ICU Intensive care unit TNF Tumor necrosis factor TACE Trans-arterial chemoembolization AFP Alph
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