Textbook outcome and nomogram-guided approaches for enhancing surgical success in elderly HCC patients: Deciphering the influence of sarcopenia.

Autor: Lanari J; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy. jacopo.lanari@unipd.it.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy. jacopo.lanari@unipd.it., Lupi A; Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy., Billato I; Department of Biology, University of Padua, Padua, Italy., Alessandris R; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Crimì F; Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy., Caregari S; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Pepe A; Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy., D'Amico FE; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Vitale A; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Quaia E; Institute of Radiology, Department of Medicine, Padua University Hospital, University of Padua, Padua, Italy., Cillo U; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy., Gringeri E; Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.; General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Padua University Hospital, Padua, Italy.
Jazyk: angličtina
Zdroj: Updates in surgery [Updates Surg] 2024 Oct 07. Date of Electronic Publication: 2024 Oct 07.
DOI: 10.1007/s13304-024-01992-3
Abstrakt: Sarcopenia, serving as a surrogate for frailty, is clinically significant in liver resection (LR) for elderly hepatocellular carcinoma (HCC) patients. Our study aims to assess sarcopenia's impact, measured by Psoas Muscle Index (PMI), on postoperative outcomes. We retrospectively studied patients aged ≥ 60 years who underwent LR for HCC between 2014 and 2018. PMI, derived from preoperative CT scans, and Textbook Outcome (TO) for LR were assessed. A nomogram predicting overall survival (OS) was developed via multivariable analysis. Of the 149 eligible HCC patients, the median PMI was 7.225 cm 2 /m 2 in males and 4.882 cm 2 /m 2 in females, with 37 (24.8%) patients identified as sarcopenic. Mortality was significantly associated with sarcopenia (HR 2.15; p = 0.032), MELD ≥ 10 (HR 3.13; p = 0.001), > 3 HCC nodules (HR 4.97; p = 0.001), and Clavien-Dindo ≥ 3 complications (HR 3.38; p < 0.001). Sarcopenic patients had a 5-year OS of 38.8% compared to 61% for non-sarcopenic individuals (p = 0.085). Achieving TO correlated with higher OS (p = 0.01). In sarcopenic cases, the absence of postoperative complications emerged as a limiting factor. Sarcopenic patients failing to achieve TO had worse OS compared to non-sarcopenic and TO-achieving counterparts (5-year OS 18.5%; p = 0.00039). Sarcopenia emerges as a prognostic factor for LR outcomes in elderly HCC patients. Postoperative complications in sarcopenic patients may compromise oncological outcomes.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: