P-117 - Sarcopenia at First Diagnosis Predicts a Reduced Survival in Patients Affected by Hepatocarcinoma

Abstract

Introduction

Sarcopenia is a frequent complication and an independent risk factor for mortality and clinical outcomes in patients (pts) with liver cirrhosis, and in a variety of other clinical conditions. Aim of the study was to determine the prevalence of sarcopenia in a cohort of cirrhotic patients at the first diagnosis of hepatocellular carcinoma (HCC) treated in a tertiary center and its influence on survival.

Methods

All consecutive HCC pts treated at our outpatient clinic (2004-2014) undergoing abdominal Computed Tomography (CT), were retrospectively studied with a software analyzing the cross-sectional areas of muscles at L3 level. Data were normalized for height obtaining the Skeletal Muscle Index (SMI) to measure sarcopenia. Presence of sarcopenia was defined as a SMI <= 41 cm2/m2 for women, <= 53cm2/m2 for men with a body mass index (BMI) >= 25 and <= 43cm2/m2 for men with BMI <25 respectively. Statistical analysis: Fisher's exact test and the Mann Whitney test were used. Kaplan Meier method was used to determine overall survival. Results are expressed as median (range) for continuous non-parametric variables, and number/total (%) for discrete variables

Results

Complete data for evaluation were available for 92 HCC pts: 27 female (29.4%), 65 male (70.6%). Median Age at diagnosis was 71.9 years (30.7-86.4), while BMI was 24.7 (17.5-36.7). BMI in women was 23.1(17.5-36.7) vs 24.7 (18.4-36.7) in men (p = ns). Viral infection was the cause of liver disease in most cases: HCV 40/92(43.5%); HBV 11/92(12%). However alcohol 22/92 (24%) and NASH 19/92(20.5%) were also prevalent causes. Distribution by CHILD score was as follows: A = 51/92 (55.4%); B= 39/92 (42.4%); C = 2/92 (2.2%). Median MELD score was 10 (6-18). Metastatic disease was present in 11/92 (12%). The distribution by BCLC was as follows: A = 38/92 (41.3%); B = 23/92 (25%); C = 26/92(28.3%); D = 5/92(5.4%). Overall sarcopenia was present in 37/92 (40.2%). Baseline clinical and biochemical features were similar between sarcopenic vs non sarcopenic pts. Sarcopenic were prevalently females (p = 0.005). A reduced mean Overall Survival of 123(95% C.I. 98 to 150) vs 66 (95% C.I. 47 to 84) weeks (p = 0.001) was observed in sarcopenic as also calculated and showed in the Kaplan Meier curve (figure 1). Multivariate analysis has shown that sarcopenia was independent of age (p = 0.0027).

Conclusion

In this single center of Italian HCC patients the prevalence of Sarcopenia was high, with a greater frequency in female pts. Presence of Sarcopenia at diagnosis of HCC is an independent predictor of a reduced overall survival. The computerized objective method of measurement of Sarcopenia that we want to propose could help every oncologists to identify patients at increased risk for the complications of their basal oncological disease and to develop tailored management protocols.

Figure: P-117