肌肉减少症对接受TACE治疗原发性肝癌患者生存期的影响

Sarcopenia as a Predictor of Prognosis on Outcomes in Patients Undergoing Transarterial Chemoembolization(TACE)for Hepatocellular Carcinoma

目的肌肉减少症(Src)对经导管动脉化疗栓塞术(TACE)预后的影响尚不十分明确,拟评估术前Src与TACE治疗后生存期的影响。方法回顾性分析2014年1月至2018年1月在成都市第六人民医院初次诊断和接受首次TACE治疗的155例原发性肝癌(HCC)患者的资料,依据纳入排除标准筛选其中98例纳入分析。依据术前CT影像计算第三腰椎骨骼肌质量指数,判断Src的存在,分为Src组(60例)和无Src组(38例)。采用Kaplan-Meier生存分析,Log-rank比较Src组和无Src组患者肿瘤无进展生存时间(TTP)和总生存时间(OS)。在Cox比例风险回归模型下进行单因素和多因素分析TACE预后不良的相关危险因子。结果随访观察期间95.92%(94例)患者出现肿瘤进展,88.78%(87例)患者死亡。Src组患者的TTP和OS显著低于无Src组(P<0.0001)。影响TACE预后的独立危险因素包括Src(HR:2.265,95%CI:1.350~3.800;P=0.002)、肿瘤BCLC分级≥C级(HR:1.627,95%CI:1.044~2.534;P=0.031)、ECOG-PS评分≥2分(HR:1.811,95%CI:1.050~3.125;P=0.033)和血AFP>400μg/L(HR:1.867,95%CI:1.198~2.911;P=0.006)。结论61.22%的HCC患者首次接受TACE治疗前已合并Src。Src是TACE治疗总体生存欠佳的独立危险因素,可以作为HCC患者接受TACE治疗预后的预测因子。

Objective The impact of sarcopenia on outcomes of patients undergoing Transarterial Chemoembolization(TACE)remains unclear.The purpose of this study was to evaluate the relationship between preoperative sarcopenia and prognosis on outcomes of TACE.Methods A total of 155 newly diagnosed patients who underwent TACE for hepatocellular carcinoma(HCC)between January 2014 and January 2018 at the Sixth People’s Hospital of Chengdu were enrolled.Data from 98 of the patients were retrospectively analyzed according to inclusion and exclusion criteria.Skeletal muscle index at L3 were evaluated by preoperative computed tomography images to define sarcopenia.Cumulative Time to Progress(TTP)and Overall Survive(OS)rates were calculated using Kaplan-Meier methods,and differences between curves of groups(sarcopenia,n=60;non-sarcopenia,n=38)were evaluated using the log-rank test.Prognostic significance was assessed with univariate and multivariate analyses,using Cox proportional hazards models.Results 95.92%(n=94)of tumor to progress and 88.78%(n=87)of death were observed during the study period[Median 11.0(7.85,14.8)months].The TTP(P<0.0001)and OS(P<0.0001)in HCC patients with sarcopenia were significantly worse than that in HCC patients without sarcopenia.Multivariate analysis identified the presence of sarcopenia(HR,2.265;95%CI,1.350~3.800,P=0.002),Barcelona Clinic Liver Cancer(BCLC)stage≥C(HR,1.627;95%CI,1.044~2.534,P=0.031),Eastern Cooperative Oncology Group performance status(ECOG-PS)≥2(HR,1.811;95%CI,1.050~3.125,P=0.033),and serum alpha-fetoprotein(AFP)>400μg/L(HR,1.867;95%CI,1.198~2.911,P=0.006)as independent predictors of poor OS.Conclusions 61.22%of HCC patients were associated with sarcopenia before the first time they underwent TACE.Sarcopenia was an independent risk factor for poor OS and could be recognized as an independent prognostic factor in patients with HCC treated with TACE.