Myosteatosis and muscle loss impact liver transplant outcomes in male patients with hepatocellular carcinoma

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2024-08-27 DOI:10.1002/jcsm.13554

Di Lu, Zhihang Hu, Hao Chen, Abid Ali Khan, Qingguo Xu, Zuyuan Lin, Huigang Li, Jianyong Zhuo, Chiyu He, Li Zhuang, Zhe Yang, Siyi Dong, Jinzhen Cai, Shusen Zheng, Xiao Xu

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引用次数: 0

Abstract

Background

Sarcopenia is associated with unfavourable long-term survival in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). However, the impact of myosteatosis and muscle loss on patient prognosis has not been investigated.

Methods

Seven hundred fifty-six HCC patients who received LT at 3 transplant centres were included. Computed tomography (CT) images of recipients were collected to measure skeletal muscle index (SMI) and skeletal muscle radiodensity (SMRA). The impact of myosteatosis on the prognosis of sarcopenic and non-sarcopenic patients was studied separately. Muscle status was evaluated based on the presence of sarcopenia and myosteatosis. The muscle loss of 342 males was calculated as the relative change of SMI between pre- and post-LT evaluations. Cox regression models were used to identify predictors of overall survival (OS) and recurrence-free survival (RFS).

Results

The study comprised 673 males and 83 females. The median follow-up time was 31 months (interquartile range, 19–43 months). Prior to LT, 267 (39.7%) and 187 (27.8%) males were defined as sarcopenic (low-SMI) and myosteatotic (low-SMRA), respectively. For sarcopenic recipients, the presence of myosteatosis was followed by a 23.6% decrease in 5 year OS (P < 0.001) and a 15.0% decrease in 5 year RFS (P = 0.014). Univariate and multivariate analyses revealed that muscle status was an independent predictor of OS [hazard ratio (HR), 1.569; 95% confidence interval (CI), 1.317–1.869; P < 0.001] and RFS (HR, 1.369; 95% CI, 1.182–1.586; P < 0.001). Postoperatively, a muscle loss >14.2% was an independent risk factor for poor OS (HR, 2.286; 95% CI, 1.358–3.849; P = 0.002) and RFS (HR, 2.219; 95% CI, 1.418–3.471; P < 0.001) in non-sarcopenic recipients (N = 209).

Conclusions

Pre-transplant myosteatosis aggravated the adverse impact of sarcopenia on liver transplant outcomes in male HCC patients. Post-transplant muscle loss might assist in prognostic stratification of recipients without pre-existing sarcopenia, intriguing new insights into individualized management.

Abstract Image

查看原文本刊更多论文

肌营养不良和肌肉流失影响男性肝细胞癌患者的肝移植预后。

背景：肌肉疏松症与因肝细胞癌（HCC）而接受肝移植（LT）的患者的长期生存不利有关。然而，肌骨营养不良和肌肉流失对患者预后的影响尚未得到研究：方法：纳入在 3 个移植中心接受 LT 治疗的 756 名 HCC 患者。收集受者的计算机断层扫描（CT）图像，测量骨骼肌指数（SMI）和骨骼肌放射密度（SMRA）。分别研究了肌骨营养不良对肌肉疏松和非肌肉疏松患者预后的影响。根据肌肉疏松症和肌骨软化症的存在情况来评估肌肉状态。342 名男性的肌肉损失量被计算为肌肉疏松指数（SMI）在长程负荷治疗前后的相对变化。采用 Cox 回归模型确定总生存期（OS）和无复发生存期（RFS）的预测因素：研究对象包括 673 名男性和 83 名女性。中位随访时间为31个月（四分位间范围为19-43个月）。在接受LT治疗前，分别有267名（39.7%）和187名（27.8%）男性被定义为肌无力（低SMI）和肌骨软化（低SMRA）。对于肌肉疏松的受者，肌骨质疏松症会导致其5年OS下降23.6%（P=14.2%），是OS（HR，2.286；95% CI，1.358-3.849；P=0.002）和RFS（HR，2.219；95% CI，1.418-3.471；P=0.002）较差的独立风险因素：移植前肌骨质疏松症加重了肌肉疏松症对男性HCC患者肝移植预后的不利影响。移植后肌肉流失可能有助于对无肌肉疏松症的受者进行预后分层，为个体化管理提供新的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.