Changes in nutritional status in hepatocellular carcinoma patients treated with sorafenib.

Purpose: Musculoskeletal imbalance is often overlooked in clinical management, although in hepatocellular carcinoma (HCC) it has been associated with adverse outcomes. We aimed to assess the nutritional status using Computed Tomography (CT) scans, in HCC patients and its association with progression-free survival (PFS) and overall survival (OS).

Methods: A total of 122 patients were qualified for systemic therapy due to HCC, 73 for sorafenib treatment. The nutritional status was assessed using CT, Body Mass Index (BMI), the prognostic nutritional index (PNI) and on the Nutritional Risk Score (NRS) 2002 scale. The ECOG Performance Status Scale was used to assess the patients' level of functioning. The classification of the liver failure was described with the Child-Pugh scale. The Barcelona Clinic Liver Cancer classification system was used for patients management. Survival analyses were performed.

Results: NRS and BMI were not significantly related to PFS and OS. Nutritional status changed significantly during 6 months of sorafenib treatment; however, the sarcopenia was not detected. The low PNI deteriorates significantly both PFS and OS. Significant differences between median time of survival in patients that lost more than 10% in visceral or subcutaneous fat or muscle mass in comparison to those with stable parameters were noticed: Subcutaneous Adipose Tissue Index (SATI): PFS-9.5 vs 16.4 months, OS-15.95 vs 24.5 months; Visceral Adipose Tissue Index (VATI): 11 vs. 15.75 months; SMI: PFS-11.5 vs 15.75 months, OS-22 vs 24.1 months; PMI: PFS-9.2 vs 16.15 months, OS-14.5vs 24.5 months.

Conclusion: The loss in fat and muscle mass in patients undergoing sorafenib therapy for HCC was associated with poorer PFS and OS.