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Randomized Controlled Trial
. 2024 Oct;12(8):1016-1027.
doi: 10.1002/ueg2.12627. Epub 2024 Jul 15.

Skeletal muscle quality predicts overall survival in advanced liver hepatocellular carcinoma treated with SIRT and sorafenib: A subanalysis of the SORAMIC trial

Alexey Surov  1 , Andreas Wienke  2 , Jan Borggrefe  1 , Mattes Hinnerichs  3 , Ricarda Seidensticker  4 , Osman Öcal  4 , Kerstin Schütte  5   6 , Christoph J Zech  7 , Christian Loewe  8 , Otto van Delden  9 , Vincent Vandecaveye  10 , Chris Verslype  11 , Bernhard Gebauer  12 , Christian Sengel  13 , Irene Bargellini  14 , Roberto Iezzi  15 , Peter Malfertheiner  16 , Thomas Berg  17 , Heinz J Klümpen  18 , Julia Benckert  19 , Antonio Gasbarrini  20 , Holger Amthauer  21 , Bruno Sangro  22 , Jens Ricke  4 , Max Seidensticker  4
Affiliations
Randomized Controlled Trial

Skeletal muscle quality predicts overall survival in advanced liver hepatocellular carcinoma treated with SIRT and sorafenib: A subanalysis of the SORAMIC trial

Alexey Surov et al. United European Gastroenterol J. 2024 Oct.

Abstract

Background and aims: Our purpose was to assess the impact of muscle quality on overall survival (OS) in patients with advanced HCC.

Methods: This is a subanalysis of the SORAMIC trial. Overall, 363 patients were included. The SIRT/Sorafenib treatment group comprised 182 patients and the sorafenib group 181 patients. Myosteatosis was defined as skeletal muscle density (SMD) < 41 HU for patients with a body mass index up to 24.9 kg/m2 and <33 HU for patients with a body mass index ≥25 kg/m2. Albumin-gauge score was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on clinical variables and OS, a Cox regression model was used. Hazard ratios are presented together with 95 % confidence intervals (95 % CI). Kaplan-Meier curves were used for survival analysis.

Results: In the SIRT/sorafenib cohort, low albumin-gauge score was an independent predictor of worse OS, HR = 1.74, CI 95% (1.16-2.62), p = 0.01. In the sorafenib cohort, muscle quality parameters did not predict OS. In alcohol-induced HCC (n = 129), myosteatosis independently predicted OS, HR = 1.85, CI 95% (1.10; 3.12), p = 0.02. In viral-induced HCC (n = 99), parameters of muscle quality did not predict OS. In patients with NASH/Non-alcoholic fatty liver disease (NAFLD) induced HCC, albumin-gauge score was a strong independent predictor of worse OS in the subgroup undergoing combined treatment with SIRT and sorafenib, HR = 9.86, CI 95% (1.12; 86.5), p = 0.04.

Conclusions: Myosteatosis predicts independently worse OS in patients with alcohol-induced HCC undergoing combined treatment with SIRT and sorafenib. In patients with NASH/NAFLD induced HCC undergoing treatment with SIRT and sorafenib, albumin-gauge score predicts independently worse OS.

Impact and implications: Associations between parameters of muscle quality and OS are different in accordance to the treatment strategy and etiology of HCC. These findings highlight the prognostic potential of skeletal muscle quality in patients with advanced HCC.

Keywords: HCC; MASH; MASLD; albumin; alcoholic liver disease; hepatocellular cancer; myosteatosis; survival; target therapy; viral.

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Conflict of interest statement

The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

FIGURE 1
FIGURE 1
Representative cases of the patient sample. (a) Patient with high muscle mass and muscle density. (b) Patient with low muscle mass and density (myosteatosis).
FIGURE 2
FIGURE 2
OS curves according to parameters of skeletal muscle quality in the total SORAMIC cohort. (a) OS in patients grouped according to the presence of myosteatosis. (b) OS in patients with low and normal albumin‐gauge scores. OS, Overall survival.
FIGURE 3
FIGURE 3
OS curves according to parameters of skeletal muscle quality in the cohort undergoing treatment with SIRT + sorafenib. (a) OS in patients grouped according to the presence of myosteatosis. (b) OS in patients with low and normal albumin‐gauge scores. OS, Overall survival.
FIGURE 4
FIGURE 4
OS curves according to parameters of skeletal muscle quality in the cohort undergoing treatment with sorafenib alone. (a) OS in patients grouped according to the presence of myosteatosis. (b) OS in patients with low and normal albumin‐gauge scores. OS, Overall survival.
See this image and copyright information in PMC

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