Erschienen in:
23.09.2020 | Hepatobiliary Tumors
Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma
verfasst von:
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
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 1/2021
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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.