| Abstrakt: |
Background/Aims Sarcopenia, an objective surrogate for performance status, is associated with the outcomes of cirrhosis and hepatocellular carcinoma (HCC). Most patients with advanced HCC who failed sorafenib treatment had poor performance status. In this study, we aimed to determine the role of sarcopenia in advanced HCC patient after sorafenib treatment. Methods From August 2012 to March 2017 in Taipei Veterans General Hospital, 381 sorafenib- failed HCC patients who experienced radiology-proved progressive diseases were retrospectively analyzed. Sarcopenia was defined as transverse psoas muscle thickness per height less than 16.8 mm/m. Results The prevalence of sarcopenia was 64.8% at the time of sorafenib failure. Sarcopenia was female predominant and was associated with lower body mass index, chronic hepatitis C infection, larger tumor size, prolonged prothrombin time, lower serum albumin level, more ascites, and higher albumin-bilirubin (ALBI) grade. Patients with sarcopenia had significantly shorter postprogression survival (PPS) compared with the counterparts (median PPS, 3.9 vs 5.8 months; p=0.005). In multivariate analyses, large tumor size (>10 cm), high alpha-fetoprotein level (>400 ng/mL), ALBI grade, early PD within 4 months, presence of new extrahepatic metastasis, and sarcopenia were independent risk factors to postprogression mortality. After adjustment of other factors, sarcopenia remained a significant predictor to a poor PPS in sorafenib-failed HCC (hazard ratio, 1.30; p=0.029). Conclusions Sarcopenia significantly differentiates PPS and is an independent prognostic factor to determine mortality in sorafenib-failed HCC. Building muscle mass is important for advanced HCC patients after sorafenib failure before entry into second-line systemic therapy to prolong survival. [ABSTRACT FROM AUTHOR] |
