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Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma.

Abstract

BACKGROUND AND AIMS

Abnormal body composition such as severe skeletal muscle depletion or sarcopenia has emerged as an independent predictor of clinical outcomes in a variety of clinical conditions. This study is the first study to report the frequency and prognostic significance of sarcopenia as a marker of nutritional status in patients with hepatocellular carcinoma (HCC).

METHODS

We analyzed 116 patients with HCC who were consecutively evaluated for liver transplant. Skeletal muscle cross-sectional area was measured by CT. Sarcopenia was defined using previously established cutpoints.

RESULTS

Ninety-eight patients were males (85%), and the mean age was 58±6 years. Sarcopenia was present in 35 patients (30%). By univariate Cox analysis, male sex (HR, 3.84; P=0.02), lumbar skeletal muscle index (HR, 0.97; P=0.04), INR (HR, 8.18; P<0.001), MELD score (HR, 1.19; P<0.001), Child-Pugh (HR, 3.95; P<0.001), serum sodium (HR, 0.84; P<0.001), TNM stage (HR, 2.59; P<0.001), treatment type (HR, 0.53; P<0.001), and sarcopenia (HR, 2.27; P=0.004) were associated with increased risks of mortality. By multivariate Cox regression analysis, only MELD score (HR, 1.08; P=0.04), Child-Pugh (HR, 2.14; P=0.005), sodium (HR, 0.89; P=0.01), TNM stage (HR, 1.92; P<0.001), and sarcopenia (HR, 2.04; P=0.02) were independently associated with mortality. Median survival for sarcopenic patients was 16±6 versus 28±3 months in nonsarcopenic (P=0.003).

CONCLUSIONS

Sarcopenia is present in almost one third of patients with HCC, and constitutes a strong and independent risk factor for mortality. Our results highlight the importance of body composition assessment in clinical practice.

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  • Authors+Show Affiliations

    ,

    *Department of Oncology, Cross Cancer Institute †Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, AB, Canada ‡Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, FL.

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    Source

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Carcinoma, Hepatocellular
    Female
    Humans
    Liver Cirrhosis
    Liver Neoplasms
    Liver Transplantation
    Male
    Middle Aged
    Multivariate Analysis
    Neoplasm Staging
    Nutritional Status
    Prognosis
    Proportional Hazards Models
    Prospective Studies
    Risk Factors
    Sarcopenia
    Survival Analysis

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23751844

    Citation

    Meza-Junco, Judith, et al. "Sarcopenia as a Prognostic Index of Nutritional Status in Concurrent Cirrhosis and Hepatocellular Carcinoma." Journal of Clinical Gastroenterology, vol. 47, no. 10, 2013, pp. 861-70.
    Meza-Junco J, Montano-Loza AJ, Baracos VE, et al. Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. J Clin Gastroenterol. 2013;47(10):861-70.
    Meza-Junco, J., Montano-Loza, A. J., Baracos, V. E., Prado, C. M., Bain, V. G., Beaumont, C., ... Sawyer, M. B. (2013). Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. Journal of Clinical Gastroenterology, 47(10), pp. 861-70. doi:10.1097/MCG.0b013e318293a825.
    Meza-Junco J, et al. Sarcopenia as a Prognostic Index of Nutritional Status in Concurrent Cirrhosis and Hepatocellular Carcinoma. J Clin Gastroenterol. 2013;47(10):861-70. PubMed PMID: 23751844.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. AU - Meza-Junco,Judith, AU - Montano-Loza,Aldo J, AU - Baracos,Vickie E, AU - Prado,Carla M M, AU - Bain,Vincent G, AU - Beaumont,Crystal, AU - Esfandiari,Nina, AU - Lieffers,Jessica R, AU - Sawyer,Michael B, PY - 2013/6/12/entrez PY - 2013/6/12/pubmed PY - 2014/6/17/medline SP - 861 EP - 70 JF - Journal of clinical gastroenterology JO - J. Clin. Gastroenterol. VL - 47 IS - 10 N2 - BACKGROUND AND AIMS: Abnormal body composition such as severe skeletal muscle depletion or sarcopenia has emerged as an independent predictor of clinical outcomes in a variety of clinical conditions. This study is the first study to report the frequency and prognostic significance of sarcopenia as a marker of nutritional status in patients with hepatocellular carcinoma (HCC). METHODS: We analyzed 116 patients with HCC who were consecutively evaluated for liver transplant. Skeletal muscle cross-sectional area was measured by CT. Sarcopenia was defined using previously established cutpoints. RESULTS: Ninety-eight patients were males (85%), and the mean age was 58±6 years. Sarcopenia was present in 35 patients (30%). By univariate Cox analysis, male sex (HR, 3.84; P=0.02), lumbar skeletal muscle index (HR, 0.97; P=0.04), INR (HR, 8.18; P<0.001), MELD score (HR, 1.19; P<0.001), Child-Pugh (HR, 3.95; P<0.001), serum sodium (HR, 0.84; P<0.001), TNM stage (HR, 2.59; P<0.001), treatment type (HR, 0.53; P<0.001), and sarcopenia (HR, 2.27; P=0.004) were associated with increased risks of mortality. By multivariate Cox regression analysis, only MELD score (HR, 1.08; P=0.04), Child-Pugh (HR, 2.14; P=0.005), sodium (HR, 0.89; P=0.01), TNM stage (HR, 1.92; P<0.001), and sarcopenia (HR, 2.04; P=0.02) were independently associated with mortality. Median survival for sarcopenic patients was 16±6 versus 28±3 months in nonsarcopenic (P=0.003). CONCLUSIONS: Sarcopenia is present in almost one third of patients with HCC, and constitutes a strong and independent risk factor for mortality. Our results highlight the importance of body composition assessment in clinical practice. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/23751844/Sarcopenia_as_a_prognostic_index_of_nutritional_status_in_concurrent_cirrhosis_and_hepatocellular_carcinoma_ L2 - http://Insights.ovid.com/pubmed?pmid=23751844 DB - PRIME DP - Unbound Medicine ER -