Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Me
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma Martin Seror, MD1, Riccardo Sartoris, MD1,5, Christian Hobeika, MD2, Mohamed Bouattour, MD3, Vale´rie Paradis, MD, PhD4,5, Pierre-Emmanuel Rautou, MD, PhD3,5, Olivier Soubrane, MD, PhD2, Vale´rie Vilgrain, MD, PhD1,5, Franc¸ois Cauchy, MD2,5, and Maxime Ronot, MD, PhD1,5 1
Department of Radiology, Beaujon Hospital, Assistance Publique Hoˆpitaux de Paris and Universite´ de Paris, Clichy, France; 2Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hoˆpitaux de Paris and Universite´ de Paris, Clichy, France; 3Department of Hepatology, Beaujon Hospital, Assistance Publique Hoˆpitaux de Paris and Universite´ de Paris, Clichy, France; 4Department of Pathology, Beaujon Hospital, Assistance Publique Hoˆpitaux de Paris and Universite´ de Paris, Clichy, France; 5Universite´ de Paris, Centre de recherche sur l’inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
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
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09143-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 29 May 2020 Accepted: 3 August 2020 M. Ronot, MD, PhD e-mail: [email protected]
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 B2.50) to
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