Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma
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HEPATOBILIARY
Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma Aliya Qayyum1 · Priya Bhosale1 · Rizwan Aslam1 · Rony Avritscher2 · Jingfei Ma3 · Mark D. Pagel4 · Jia Sun5 · Yehia Mohamed6 · Asif Rashid7 · Laura Beretta8 · Ahmed O. Kaseb6 Received: 17 June 2020 / Revised: 27 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Sarcopenia is an independent prognostic indicator for hepatocellular carcinoma (HCC). Our objective was to determine the effect of sarcopenia on response to systemic targeted therapy in patients with advanced HCC. Materials and methods This was a retrospective, Institutional Review Board approved study of 36 patients on systemic targeted therapy with immune checkpoint blockade (n = 25) or tyrosine kinase inhibitor (n = 11) for biopsy-proven advanced HCC. Skeletal muscle index (SMI) was calculated from erector spinae muscle area (SMA) at the level of T12 on pretreatment CT: [SMI = SMA ( cm2)/height (m2)]. SMI was compared to treatment response defined as overall survival ≥ 1 year (nonsurgical patients) or > 50% HCC necrosis (surgical patients). Receiver operating characteristic curve and area under the curve was used for analysis with p 50% necrosis in resected HCC (after 6 weeks of neoadjuvant treatment) by pathology review for surgical patients.
Imaging CT scans through the chest were obtained on a 64-slice multi-detector CT (GE, Milwaukee, Wisconsin). Intravenous iodinated contrast (2.0 mL/kg iohexol 300) was administered at a rate of 3–5 mL/s. Images were acquired in the arterial phase (20 s after start of contrast injection).
Abdominal Radiology
CT images reconstructed at 2.5 mm slice thickness were used for interpretation.
Image analysis Bilateral erector spinae muscle area measurements were obtained at the level of the lower third of the T12 vertebral body. Image analysis was performed in a blinded manner by a single radiologist. Although outcome data with liver MRI findings for some of the subjects have been previously published [11], the muscle measurements were performed on images from the pretreatment clinical chest CT without data on treatment response. The erector spinae muscles were manually segmented on our picture archiving and communication system (Philips Medical, Andover MA) using a single axial CT image, Fig. 1. The single axial image was selected from the lower third of the T12 vertebral body. The segmented area of the erector spinae muscle area measurement (cm2) was converted to a skeletal muscle index (SMI) by dividing by the square of the patient’s height (m2) [8, 9]. The pretreatment skeletal muscle index for men and women was compared to treatment response defined as overall survival ≥ 1 year or > 50% necrosis of the resected HCC.
Pathologic analysis The pathologic review was performed as part of the parent clinical trial by a liver pathologist (A.R.) with more than 20 years of experience. Study-specific identifiers we
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