骨骼肌质量可预测晚期肝细胞癌患者的总生存期：SORAMIC试验的亚分析

Skeletal muscle quality predicts overall survival in advanced liver hepatocellular carcinoma treated with SIRT and sorafenib: A subanalysis of the SORAMIC trial

United European Gastroenterology Journal

影响因子:6.7

分区:医学2区 / 胃肠肝病学3区

发表日期:2024 Oct

作者: Alexey Surov, Andreas Wienke, Jan Borggrefe, Mattes Hinnerichs, Ricarda Seidensticker, Osman Öcal, Kerstin Schütte, Christoph J Zech, Christian Loewe, Otto van Delden, Vincent Vandecaveye, Chris Verslype, Bernhard Gebauer, Christian Sengel, Irene Bargellini, Roberto Iezzi, Peter Malfertheiner, Thomas Berg, Heinz J Klümpen, Julia Benckert, Antonio Gasbarrini, Holger Amthauer, Bruno Sangro, Jens Ricke, Max Seidensticker

DOI: 10.1002/ueg2.12627

摘要

本研究旨在评估肌肉质量对晚期肝细胞癌（HCC）患者总生存期（OS）的影响。此次为SORAMIC试验的亚分析。共纳入363名患者，其中SIRT/索拉非尼组182名，索拉非尼组181名。肌肉脂肪变性定义为骨骼肌密度（SMD）<41 HU（体重指数（BMI）≤24.9 kg/m2）或<33 HU（BMI≥25 kg/m2）。血清白蛋白乘以SMD得分（白蛋白-评分），用于评估肌肉质量与临床变量和OS的关系，采用Cox回归模型，显示风险比及95%置信区间（95% CI）。使用Kaplan-Meier曲线进行生存分析。在SIRT/索拉非尼组，低白蛋白-评分是预示较差OS的独立预测因素，HR=1.74（95% CI 1.16-2.62，p=0.01）。在索拉非尼组，肌肉质量参数未能预测OS。在酒精诱导的HCC（n=129）中，肌肉脂肪变性独立预测OS，HR=1.85（95% CI 1.10-3.12，p=0.02）。在病毒性HCC（n=99）中，肌肉质量参数未显示预测作用。对于非酒精性脂肪性肝病（NAFLD）诱导的HCC，白蛋白-评分在接受SIRT与索拉非尼联合治疗的亚组中是预示较差OS的强预测指标，HR=9.86（95% CI 1.12-86.5，p=0.04）。肌肉脂肪变性在接受联合治疗的酒精性HCC患者中独立预测较差的OS。在NAFLD诱导的HCC患者中，白蛋白-评分也能独立预测较差的OS。肌肉质量参数与OS之间的关系因治疗策略和肝癌病因而异。这些发现强调了骨骼肌质量在晚期HCC患者中的预后潜力。

Abstract

Our purpose was to assess the impact of muscle quality on overall survival (OS) in patients with advanced HCC.This is a subanalysis of the SORAMIC trial. Overall, 363 patients were included. The SIRT/Sorafenib treatment group comprised 182 patients and the sorafenib group 181 patients. Myosteatosis was defined as skeletal muscle density (SMD) < 41 HU for patients with a body mass index up to 24.9 kg/m2 and <33 HU for patients with a body mass index ≥25 kg/m2. Albumin-gauge score was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on clinical variables and OS, a Cox regression model was used. Hazard ratios are presented together with 95 % confidence intervals (95 % CI). Kaplan-Meier curves were used for survival analysis.In the SIRT/sorafenib cohort, low albumin-gauge score was an independent predictor of worse OS, HR = 1.74, CI 95% (1.16-2.62), p = 0.01. In the sorafenib cohort, muscle quality parameters did not predict OS. In alcohol-induced HCC (n = 129), myosteatosis independently predicted OS, HR = 1.85, CI 95% (1.10; 3.12), p = 0.02. In viral-induced HCC (n = 99), parameters of muscle quality did not predict OS. In patients with NASH/Non-alcoholic fatty liver disease (NAFLD) induced HCC, albumin-gauge score was a strong independent predictor of worse OS in the subgroup undergoing combined treatment with SIRT and sorafenib, HR = 9.86, CI 95% (1.12; 86.5), p = 0.04.Myosteatosis predicts independently worse OS in patients with alcohol-induced HCC undergoing combined treatment with SIRT and sorafenib. In patients with NASH/NAFLD induced HCC undergoing treatment with SIRT and sorafenib, albumin-gauge score predicts independently worse OS.Associations between parameters of muscle quality and OS are different in accordance to the treatment strategy and etiology of HCC. These findings highlight the prognostic potential of skeletal muscle quality in patients with advanced HCC.