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Open Access 01-12-2021 | Obesity | Research

The role of muscle depletion and visceral adiposity in HCC patients aged 65 and over undergoing TACE

Authors: Jihye Lim, Kyung Won Kim, Yousun Ko, Il-Young Jang, Yung Sang Lee, Young-Hwa Chung, Han Chu Lee, Young-Suk Lim, Kang Mo Kim, Ju Hyun Shim, Jonggi Choi, Danbi Lee

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

The incidence of hepatocellular carcinoma (HCC) has been increasing among the elderly populations. Trans-arterial chemoembolization (TACE), a widely used first-line non-curative therapy for HCCs is an issue in geriatrics. We investigated the prognosis of elderly HCC patients treated with TACE and determined the factors that affect the overall survival.

Methods

We included 266 patients who were older than 65 years and had received TACE as initial treatment for HCC. We analyzed the skeletal muscle index (SMI) and visceral-to-subcutaneous fat ratio (VSR) around the third lumbar vertebrae using computed tomography scans. Muscle depletion with visceral adiposity (MDVA) was defined by falling below the median SMI and above the median VSR value sex-specifically. We evaluated the overall survival in association with MDVA and other clinical factors.

Results

The mean age was 69.9 ± 4.5 years, and 70.3% of the patients were men. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, 29, 136, and 101 patients were classified as BCLC 0, A, and B stages, respectively, and 79 (29.7%) had MDVA. During the median follow-up of 4.1 years, patients with MDVA had a shorter life expectancy than those without MDVA (P = 0.007) even though MDVA group had a higher objective response rate after the first TACE (82.3% vs. 75.9%, P = 0.035). Multivariate analysis revealed that MDVA (Hazard ratio [HR] 1.515) age (HR 1.057), liver function (HR 1.078), tumor size (HR 1.083), serum albumin level (HR 0.523), platelet count (HR 0.996), tumor stage (stage A, HR 1.711; stage B, HR 2.003), and treatment response after the first TACE treatment (HR 0.680) were associated with overall survival.

Conclusions

MDVA is a critical prognostic factor for predicting survival in the elderly patients with HCC who have undergone TACE.

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Title: The role of muscle depletion and visceral adiposity in HCC patients aged 65 and over undergoing TACE
Authors: Jihye Lim
Kyung Won Kim
Yousun Ko
Il-Young Jang
Yung Sang Lee
Young-Hwa Chung
Han Chu Lee
Young-Suk Lim
Kang Mo Kim
Ju Hyun Shim
Jonggi Choi
Danbi Lee
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Obesity
Obesity
Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08905-2

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