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Open Access 07-10-2024 | Sarcopenia | Original Article

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

Authors: Jacopo Lanari, Amalia Lupi, Ilaria Billato, Remo Alessandris, Filippo Crimì, Silvia Caregari, Alessia Pepe, Francesco Enrico D’Amico, Alessandro Vitale, Emilio Quaia, Umberto Cillo, Enrico Gringeri

Published in: Updates in Surgery

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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.
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Metadata
Title
Textbook outcome and nomogram-guided approaches for enhancing surgical success in elderly HCC patients: Deciphering the influence of sarcopenia
Authors
Jacopo Lanari
Amalia Lupi
Ilaria Billato
Remo Alessandris
Filippo Crimì
Silvia Caregari
Alessia Pepe
Francesco Enrico D’Amico
Alessandro Vitale
Emilio Quaia
Umberto Cillo
Enrico Gringeri
Publication date
07-10-2024
Publisher
Springer International Publishing
Published in
Updates in Surgery
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-024-01992-3
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