Top

Published in:

01-01-2021 | Computed Tomography | Hepatobiliary Tumors

Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma

Authors: Martin Seror, MD, Riccardo Sartoris, MD, Christian Hobeika, MD, Mohamed Bouattour, MD, Valérie Paradis, MD, PhD, Pierre-Emmanuel Rautou, MD, PhD, Olivier Soubrane, MD, PhD, Valérie Vilgrain, MD, PhD, François Cauchy, MD, Maxime Ronot, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2021

Abstract

Objective

The aim of this study was to assess the prognostic value of liver surface nodularity (LSN) and sarcopenia from preoperative computed tomography (CT) in patients with resectable metabolic syndrome (MS)-related hepatocellular carcinoma (HCC).

Methods

Patients with MS undergoing hepatectomy for HCC between 2006 and 2018 at a single center were retrospectively analyzed. LSN and sarcopenia were assessed on preoperative CT scans, and their association with severe (Clavien–Dindo grade 3–5) postoperative complications was analyzed on multivariate analysis. The influence of LSN and sarcopenia on overall survival (OS) and recurrence-free survival (RFS) was assessed.

Results

Overall, 110 patients (92 men [84%], mean 67.7 ± 7.7 years of age) were analyzed. Severe postoperative complications occurred in 34/110 (31%) patients. Patients with severe complications had a significantly higher LSN score (area under the receiver operating characteristic curve 0.68 ± 0.05, optimal cut-off > 2.50) and were more frequently sarcopenic (47% vs. 13% without major complications, p < 0.001). Multivariate analysis identified sarcopenia (odds ratio [OR] 6.51, 95% confidence interval [CI] 2.08–20.39; p < 0.001), LSN > 2.50 (OR 7.05, 95% CI 2.13–23.35; p < 0.001), and preoperative portal vein embolization (PVE; OR 6.06, 95% CI 1.71–21.48; p = 0.005) as independent predictors of severe complications. LSN and sarcopenia had no influence on OS. Stratification according to a combination of LSN > 2.50 and sarcopenia predicted the risk of severe postoperative complications from 7% (no sarcopenia and LSN ≤2.50) to 71% (sarcopenia and LSN > 2.50; p < 0.001), as well as RFS from 61 months (95% CI 40–82) to 17 months (95% CI 9–25; p = 0.033). Results remained significant in 52 patients without advanced fibrosis.

Conclusions

The combination of LSN and sarcopenia derived from routine preoperative CT seems to help predict severe postoperative complications and stratification of RFS in patients with MS and resectable HCC.

Available only for authorised users

Scuteri A, Laurent S, Cucca F, et al. Metabolic syndrome across Europe: different clusters of risk factors. Eur J Prev Cardiol. 2015;22(4):486–91. https://doi.org/10.1177/2047487314525529.CrossRefPubMed

Cauchy F, Zalinski S, Dokmak S, et al. Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome. Br J Surg. 2013;100(1):113–21. https://doi.org/10.1002/bjs.8963.CrossRefPubMed

Kim HS, El-Serag HB. The epidemiology of hepatocellular carcinoma in the USA. Curr Gastroenterol Rep. 2019;21(4):17. https://doi.org/10.1007/s11894-019-0681-x.CrossRefPubMed

Estes C, Anstee QM, Arias-Loste MT, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016–2030. J Hepatol. 2018;69(4):896–904. https://doi.org/10.1016/j.jhep.2018.05.036.CrossRefPubMed

Reddy SK, Marsh JW, Varley PR, et al. Underlying steatohepatitis, but not simple hepatic steatosis, increases morbidity after liver resection: a case-control study. Hepatology. 2012;56(6):2221–30. https://doi.org/10.1002/hep.25935.CrossRefPubMed

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412–23. https://doi.org/10.1093/ageing/afq034.CrossRefPubMedPubMedCentral

Zhang H, Lin S, Gao T, et al. Association between sarcopenia and metabolic syndrome in middle-aged and older non-obese adults: a systematic review and meta-analysis. Nutrients. 2018;10(3):pii:E364. https://doi.org/10.3390/nu10030364.CrossRef

Mitchell WK, Williams J, Atherton P, et al. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength: a quantitative review. Front Physiol. 2012;3:260. https://doi.org/10.3389/fphys.2012.00260.CrossRefPubMedPubMedCentral

Hamaguchi Y, Kaido T, Okumura S, et al. Muscle steatosis is an independent predictor of postoperative complications in patients with hepatocellular carcinoma. World J Surg. 2016;40(8):1959–68. https://doi.org/10.1007/s00268-016-3504-3.CrossRefPubMed

10.

Kobayashi A, Kaido T, Hamaguchi Y, et al. Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg. 2019;269(5):924–31. https://doi.org/10.1097/sla.0000000000002555.CrossRefPubMed

11.

Smith AD, Zand KA, Florez E, et al. Liver surface nodularity score allows prediction of cirrhosis decompensation and death. Radiology. 2017;283(3):711–722. https://doi.org/10.1148/radiol.2016160799.CrossRefPubMed

12.

Sartoris R, Rautou PE, Elkrief L, et al. Quantification of liver surface nodularity at CT: utility for detection of portal hypertension. Radiology. 2018;289(3):698–707. https://doi.org/10.1148/radiol.2018181131.CrossRefPubMed

13.

Hobeika C, Cauchy F, Sartoris R, et al. Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma. Br J Surg. 2020;107(7):878–88. https://doi.org/10.1002/bjs.11511.CrossRefPubMed

14.

National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106(25):3143–421.

15.

Galle PR, Forner A, Llovet JM, et al. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236. https://doi.org/10.1016/j.jhep.2018.03.019.CrossRef

16.

Coinaud C. Liver lobes and segments: notes on the anatomical architecture and surgery of the liver. Presse Med. 1954;62(33):709–12.

17.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral

18.

Kleiner DE, Brunt EM, Van Natta M, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 2005;41(6):1313–21.CrossRefPubMed

19.

Bedossa P, FLIP Pathology Consortium. Utility and appropriateness of the fatty liver inhibition of progression (FLIP) algorithm and steatosis, activity, and fibrosis (SAF) score in the evaluation of biopsies of nonalcoholic fatty liver disease. Hepatology. 2014;60(2):565–75. https://doi.org/10.1002/hep.27173.CrossRefPubMed

20.

Sartoris R, Lazareth M, Nivolli A, et al. CT-based liver surface nodularity for the detection of clinically significant portal hypertension: defining measurement quality criteria. Abdom Radiol (NY). 2020;45(9):2755–63. https://doi.org/10.1007/s00261-020-02519-1.CrossRef

21.

Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9(7):629–35. https://doi.org/10.1016/s1470-2045(08)70153-0.CrossRefPubMed

22.

Voron T, Tselikas L, Pietrasz D, et al. Sarcopenia impacts on short- and long-term results of hepatectomy for hepatocellular carcinoma. Ann Surg. 2015;261(6):1173–83. https://doi.org/10.1097/sla.0000000000000743.CrossRefPubMed

23.

Zhang G, Meng S, Li R, Ye J, Zhao L. Clinical significance of sarcopenia in the treatment of patients with primary hepatic malignancies, a systematic review and meta-analysis. Oncotarget. 2017;8(60):102474–85. https://doi.org/10.18632/oncotarget.19687.CrossRefPubMedPubMedCentral

24.

Harimoto N, Shirabe K, Yamashita YI, et al. Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013;100(11):1523–30. https://doi.org/10.1002/bjs.9258.CrossRefPubMed

25.

Fujiwara N, Nakagawa H, Kudo Y, et al. Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol. 2015;63(1):131–40. https://doi.org/10.1016/j.jhep.2015.02.031.CrossRefPubMed

26.

Chang KV, Chen JD, Wu WT. Association between loss of skeletal muscle mass and mortality and tumor recurrence in hepatocellular carcinoma: a systematic review and meta-analysis. Liver Cancer. 2018;7(1):90–103. https://doi.org/10.1159/000484950.CrossRefPubMed

27.

Lo GC, Besa C, King MJ, et al. Feasibility and reproducibility of liver surface nodularity quantification for the assessment of liver cirrhosis using CT and MRI. Eur J Radiol Open. 2017;4:95–100. https://doi.org/10.1016/j.ejro.2017.07.001.CrossRefPubMedPubMedCentral

28.

De Vos N, Sartoris R, Cauchy F, et al. Performance of liver surface nodularity quantification for the diagnosis of portal hypertension in patients with cirrhosis: comparison between MRI with hepatobiliary phase sequences and CT. Abdom Radiol (NY). 2020;45(2):365–72. https://doi.org/10.1007/s00261-019-02355-y.CrossRefPubMed

Title: Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma
Authors: Martin Seror, MD
Riccardo Sartoris, MD
Christian Hobeika, MD
Mohamed Bouattour, MD
Valérie Paradis, MD, PhD
Pierre-Emmanuel Rautou, MD, PhD
Olivier Soubrane, MD, PhD
Valérie Vilgrain, MD, PhD
François Cauchy, MD
Maxime Ronot, MD, PhD
Publication date: 01-01-2021
Publisher: Springer International Publishing
Keywords: Computed Tomography
Sarcopenia
Computed Tomography
Liver Resection
Liver Resection
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: Annals of Surgical Oncology / Issue 1/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-020-09143-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Is it Wise to Omit Sentinel Node Biopsy in Elderly Patients with Breast Cancer?

ASO Author Reflections: Impact of Ground-Glass Opacity Components in Long-Term Survivors with Resected Lung Adenocarcinoma

Do Religious/Spiritual Preferences and Needs of Cancer Patients Vary Based on Clinical- and Treatment-Level Factors?

Hepatobiliary Disease Resection in Patients with Advanced Epithelial Ovarian Cancer: Prognostic Role and Optimal Cytoreduction

Impact of Postoperative Chemotherapy on the Survival of Patients with High-Grade Gastroenteropancreatic Neuroendocrine Carcinoma

Long-Term Safety of Delayed Surgery After Upfront Endoscopic Resection for Early Gastric Cancer: A Propensity Matched Study