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by Annalisa Cespiati SciProfiles Scilit Preprints.org Google Scholar Daniel Smith SciProfiles Scilit Preprints.org Google Scholar Rosa Lombardi SciProfiles Scilit Preprints.org Google Scholar Rosa Lombardi is currently an Associate Professor of Internal Medicine at the University ofMilan,[...] Read more Anna Ludovica Fracanzani SciProfiles Scilit Preprints.org Google Scholar Anna Ludovica Fracanzani has been Head of Complex Unit of Medicine and Metabolic Disease(Internal[...] Read moreAnnalisa Cespiati
,
Daniel Smith
Rosa Lombardi
and
Anna Ludovica Fracanzani
1
SC Medicina ad Indirizzo Metabolico, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy
2
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(13), 2315; https://doi.org/10.3390/cancers16132315
Submission received: 4 April 2024 / Revised: 28 May 2024 / Accepted: 19 June 2024 / Published: 24 June 2024
(This article belongs to the Special Issue Hepatocellular Carcinoma: Advances and Challenges in Research and Treatment)
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Simple Summary
This paper discusses the importance of addressing sarcopenia in patients with hepatocellular carcinoma (HCC). The aim is to analyze how sarcopenia affects treatment outcomes for HCC, including liver transplantation, surgical resection, locoregional treatments, and systemic therapies. Sarcopenia is prevalent among HCC patients and independently correlates with lower overall survival, recurrence-free survival, and progression-free survival across all treatment modalities. Sarcopenia also increases the rate and severity of adverse events, particularly in surgery and systemic therapies. This research highlights the need for evaluating sarcopenia before HCC treatment initiation to better predict patient prognosis and tailor treatment approaches accordingly. However, the impact of sarcopenia on HCC recurrence and spread beyond the liver remains poorly understood, indicating a need for further research in this area. Overall, this research sheds light on the significance of considering sarcopenia in HCC management and may prompt efforts to identify therapies that can address muscle loss in these patients, potentially improving treatment outcomes and patient care.
Abstract
Introduction: Hepatocellular carcinoma (HCC) represents a major global health concern, characterized by evolving etiological patterns and a range of treatment options. Among various prognostic factors, sarcopenia, characterized by loss of skeletal muscle mass, strength, and function, has emerged as a pivotal contributor to HCC outcomes. Focusing on liver transplantation, surgical resection, locoregional treatments, and systemic therapies, this review aims to analyze the impact of sarcopenia on HCC treatment outcomes, shedding light on an underexplored subject in the pursuit of more personalized management. Methods: A comprehensive literature review was conducted by searching peer-reviewed articles on sarcopenia and treatment outcomes in patients with HCC from inception up to October 2023. Results: Sarcopenia was found to be prevalent among HCC patients, exhibiting different occurrence, possibly attributable to diverse diagnostic criteria. Notably, despite variations in studies utilizing skeletal muscle indices, sarcopenia independently correlated with lower overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) across surgical (both transplantation and resection), locoregional, and systemic therapies, including tyrosine-kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs). Moreover, a link between sarcopenia and increased rate and severity of adverse events, particularly in surgery and TKIs recipients, and larger tumor size at diagnosis was observed. While baseline sarcopenia negatively influenced treatment outcomes, alterations in muscle mass post-treatment emerged as primary determinants of reduced OS. Conclusions: Sarcopenia, either present before or after HCC treatment, negatively correlates with response to it, across all etiologies and therapeutic strategies. Although only a few studies have evaluated the impact of supervised physical activity training on muscle mass and OS after HCC treatment, it is crucial to evaluate the presence of sarcopenia before treatment initiation, to better stratify patients’ prognosis, thus performing a more tailored approach, and identify therapies able to restore muscle mass in HCC patients. Conversely, the impact of sarcopenia on HCC recurrence and extrahepatic spread remains inadequately explored.
Keywords: hepatocellular carcinoma; sarcopenia; HCC treatment; liver transplantation; resection; locoregional therapies; systemic therapies; overall survival; HCC recurrence
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MDPI and ACS Style
Cespiati, A.; Smith, D.; Lombardi, R.; Fracanzani, A.L. The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes. Cancers 2024, 16, 2315. https://doi.org/10.3390/cancers16132315
AMA Style
Cespiati A, Smith D, Lombardi R, Fracanzani AL. The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes. Cancers. 2024; 16(13):2315. https://doi.org/10.3390/cancers16132315
Chicago/Turabian Style
Cespiati, Annalisa, Daniel Smith, Rosa Lombardi, and Anna Ludovica Fracanzani. 2024. "The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes" Cancers 16, no. 13: 2315. https://doi.org/10.3390/cancers16132315
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