https://orcid.org/0000-0001-6622-8778
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Abstract
Objective
To investigated the association between sarcopenia and the prognosis and adverse events of hepatocellular carcinoma (HCC) patients undergoing interventional therapy combined with immunotherapy and targeted therapy.
Methods
Between January 2019 and December 2022, patients with unresectable HCC who received interventional therapy combined with immunotherapy and targeted therapy were included in this study. Total skeletal muscle area at the L3 level was normalized for height in m2 as the skeletal muscle index (SMI). All patients were divided into low and high SMI group according to the median SMI.
Results
Ninety-six consecutive patients were included eventually, with 49 patients in the high-SMI group and 47 patients in the low-SMI group. In the low-SMI group, the median overall survival (OS) was 459.00 days (95% CI, 334.76–583.24 days), and the 3-, 6-, and 12-month OS rates were 100%, 89.4% and 68.1%, respectively. In the high-SMI group, the median OS was not reached, and the 3-, 6-, and 12-month OS rates were 100%, 98% and 79.5%, respectively (p<0.05). SMI and Barcelona Clinic Liver Cancer (BCLC) C stage were independent prognostic factors for OS (p<0.05). In the low-SMI group, 26 patients had treatment-related adverse events (TRAEs), resulting in dose adjustment or treatment suspension for 10 patients. In the high-SMI group, 33 patients had TRAEs, and 18 patients received dose adjustment or treatment suspension; the between-group difference was nonsignificant (p>0.05).
Conclusion
SMI is associated with the prognosis of HCC patients receiving interventional therapy combined with immunotherapy and targeted therapy, and sarcopenia is an independent risk factor for OS. However, sarcopenia does not seem to predict the occurrence of adverse events.
Abbreviations
AEs, adverse events; BMI, body mass index; BCLC, barcelona clinic liver cancer; HU, hounsfield units; HCC, hepatocellular carcinoma; ICIs, immune checkpoint inhibitors; SMI, skeletal muscle index; TKIs, tyrosine kinase inhibitors; TACE, transarterial chemoembolization; TRAEs, treatment-related adverse events.
Data Sharing Statement
The raw data supporting the conclusions of this article will be made available by Hongcai Yang and Tianhao Cong, without undue reservation.
Ethics Statement
The studies involving human participants were reviewed and approved by the Ethics Committee of the Cancer Hospital of the Chinese Academy of Medical Sciences. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
Statement of Ethics
This is a retrospective study and involved no intervention, and all data was deidentified, the ethics committee waived the requirement for informed consent. Patient data and confidentiality were respected by the Declaration of Helsinki.
Acknowledgment
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author Contributions
Hongcai Yang and Tianhao Cong contributed equally to this work and are co-first authors. Each author made substantial contributions to the work presented, whether it was through conception, study design, execution, data collection, analysis, and interpretation, or in all of these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.