Sarcopenia Can Predict Post-Hepatectomy Survival

A new study suggests that sarcopenia can predict worse overall survival for hepatocellular carcinoma (HCC) following partial hepatectomy.

Researchers at Kyushu University (Fukuoka, Japan) retrospectively collected data for 186 consecutive patients who underwent hepatectomy for HCC with curative intent between January 2004 and December 2009. Patients were assigned to one of two groups according to the clinical presence or absence of sarcopenia. They were also assessed by computerized tomography (CT) measurement of muscle mass at the level of the third lumbar vertebra, and clinic-pathological, surgical outcome, and long-term survival data were analyzed.

The results showed that sarcopenia was present in 40.3% of the patients, and was significantly correlated with female sex, lower body mass index (BMI), and liver dysfunction, as indicated by abnormal serum albumin levels and indocyanine green retention test at 15-minute values. In patients with and without sarcopenia, the 5-year overall survival rate was 71% and 83.7% respectively, and the 5-year recurrence-free survival rate was 13% and 33.2% respectively. Analysis revealed that reduced skeletal muscle mass was also predictive of an unfavorable prognosis. The study was published in the October 2013 issue of the British Journal of surgery (BJS).

“The present study investigated the effect of sarcopenia on short- and long-term outcomes following partial hepatectomy for hepatocellular carcinoma, and aimed to identify prognostic factors,” said lead author Norifumi Harimoto, MD, PhD, and colleagues of the department of surgery and science. “Sarcopenia was predictive of worse overall survival, even when adjusted for other known predictors.”

Sarcopenia (from the Greek, meaning "poverty of flesh") is the degenerative loss of skeletal muscle mass. It is characterized first by muscle atrophy, along with a reduction in muscle tissue quality, caused by such factors as replacement of muscle fibers with fat, an increase in fibrosis, changes in muscle metabolism, oxidative stress, and degeneration of the neuromuscular junction. Combined, these changes lead to progressive loss of muscle function and frailty. Sarcopenia can thus be thought of as a muscular analog of osteoporosis, also caused by inactivity and counteracted by exercise. The combination of osteoporosis and sarcopenia results in the significant frailty often seen in the elderly population.

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