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. 2024 Nov;76(7):2645-2654.
doi: 10.1007/s13304-024-01992-3. Epub 2024 Oct 7.

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

Jacopo Lanari  1   2 , Amalia Lupi  3 , Ilaria Billato  4 , Remo Alessandris  5   6 , Filippo Crimì  3 , Silvia Caregari  5   6 , Alessia Pepe  3 , Francesco Enrico D'Amico  5   6 , Alessandro Vitale  5   6 , Emilio Quaia  3 , Umberto Cillo  5   6 , Enrico Gringeri  5   6
Affiliations

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

Jacopo Lanari et al. Updates Surg. 2024 Nov.

Abstract

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 cm2/m2 in males and 4.882 cm2/m2 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.

Keywords: Cirrhosis; Hepatocellular carcinoma; Nomogram; Psoas muscle index; Sarcopenia; Textbook outcome.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article. Research involving human participants and/or animals: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This retrospective study involving human participants was conducted in accordance with the ethical standards of the institutional and national research committee and the Declaration of Helsinki (as revised in 2013). The study was approved by the ethics board of Territorial Ethics Committee Central—Eastern Veneto Area (CET–ACEV)—Regional Resolution No. 330/2023 (protocol number 448n/A0/23, 18 January 2024). Informed consent: Each patient gave informed consent for every procedure performed and for the use of data for research and publication purposes.

Figures

Fig. 1
Fig. 1
Psoas muscle area (PMA) measurement on a preoperative CT scan cross-section, calculated at the level of the 3rd lumbar vertebra. Psoas muscle margins are manually delineated to obtain both surface areas (yellow lines)
Fig. 2
Fig. 2
The proportion of patients who achieved each desired health outcome forming the textbook outcome (TO) in the whole population, and the two groups individually
Fig. 3
Fig. 3
Kaplan–Meier survival curves of the study population stratified according to sarcopenia status (a); Kaplan–Meier survival curves of the study population stratified according to textbook outcome (TO) achievement (b); Kaplan–Meier survival curves of the study population stratified according to both sarcopenia status and TO achievement (c)
Fig. 4
Fig. 4
Nomogram to predict post-operative survival probability
See this image and copyright information in PMC

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