Impact of sarcopenia on outcomes following intra-arterial therapy of hepatic malignancies

Abstract

Background: Assessment of patient performance status is often subjective. Sarcopenia--measurement of muscle wasting--may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT).

Methods: Total psoas area (TPA) was measured on cross-sectional imaging in 216 patients undergoing IAT of hepatic malignancies between 2002 and 2012. Sarcopenia was defined as TPA in the lowest sex-specific quartile. Impact of sarcopenia was assessed relative to other clinicopathological factors.

Results: Indications for IAT included hepatocellular carcinoma (51 %), intrahepatic cholangiocarcinoma (13 %), colorectal liver metastasis (7 %), or other metastatic disease (30 %). Median TPA among men (568 mm(2)/m(2)) was greater than women (413 mm(2)/m(2)). IAT involved conventional chemoembolization (54 %), drug-eluting beads (40 %), or yttrium-90 (6 %). Median tumor size was 5.8 cm; most patients had multiple lesions (74 %). Ninety-day mortality was 9.3 %; 3-year survival was 39 %. Factors associated with risk of death were tumor size (HR = 1.84) and Child's score (HR = 2.15) (all P < 0.05). On multivariate analysis, sarcopenia remained independently associated with increased risk of death (lowest vs. highest TPA quartile, HR = 1.84; P = 0.04). Sarcopenic patients had a 3-year survival of 28 vs. 44 % for non-sarcopenic patients.

Conclusions: Sarcopenia was an independent predictor of mortality following IAT with sarcopenic patients having a twofold increased risk of death. Sarcopenia is an objective measure of frailty that can help clinical decision-making regarding IAT for hepatic malignancies.

Fig. 1

Total psoas area (TPA) was measured at the level of L3 on the first image with both vertebral spines visible. Measurements were performed in a semi-automated fashion with manual outlining of psoas muscle borders and setting the density threshold between –30 and 110 Hounsfield units (HU) (From Peng et al., with permission)

Fig. 2

a Distribution of total psoas area (TPA)/square meter stratified by gender; mean-adjusted TPA was statistically lower for women than men (413 vs. 568 mm²/m², P <0.001). b Distribution of TPA/square meter according to age

Fig. 3

Overall survival stratified by a sarcopenia (TPA/square meter) and b TPA/square meter divided into quartiles. The presence of sarcopenia was associated with risk of death (lowest vs. highest quartile TPA, HR=2.20; P =0.02)