我们的目的是评估肌肉质量对晚期 HCC 患者总生存 (OS) 的影响。这是 SORAMIC 试验的亚分析。总共包括 363 名患者。 SIRT/索拉非尼治疗组有 182 名患者，索拉非尼组有 181 名患者。肌脂肪变性的定义是，对于体重指数高达 24.9 kg/m2 的患者，骨骼肌密度 (SMD) < 41 HU；对于体重指数 ≥ 25 kg/m2 的患者，骨骼肌密度 (SMD) < 33 HU。白蛋白量表评分计算如下：血清白蛋白 (g/dL) × SMD (HU)。为了评估肌肉质量对临床变量和 OS 的影响，使用了 Cox 回归模型。风险比与 95% 置信区间 (95% CI) 一起呈现。 Kaplan-Meier 曲线用于生存分析。在 SIRT/索拉非尼队列中，低白蛋白量表评分是 OS 较差的独立预测因子，HR = 1.74，CI 95% (1.16-2.62)，p = 0.01。在索拉非尼队列中，肌肉质量参数不能预测 OS。在酒精诱发的 HCC (n = 129) 中，肌脂肪变性独立预测 OS，HR = 1.85，CI 95% (1.10; 3.12)，p = 0.02。在病毒诱发的 HCC (n = 99) 中，肌肉质量参数并不能预测 OS。在 NASH/非酒精性脂肪性肝病 (NAFLD) 诱发的 HCC 患者中，白蛋白量表评分是接受 SIRT 和索拉非尼联合治疗的亚组中 OS 较差的强有力的独立预测因子，HR = 9.86，CI 95% (1.12; 86.5)，p = 0.04。肌脂肪变性独立预测接受 SIRT 和索拉非尼联合治疗的酒精诱发 HCC 患者的 OS 较差。在接受 SIRT 和索拉非尼治疗的 NASH/NAFLD 诱发 HCC 患者中，白蛋白量表评分独立预测较差的 OS。肌肉质量参数与 OS 之间的关联根据 HCC 的治疗策略和病因而不同。这些发现强调了骨骼肌质量对晚期 HCC 患者的预后潜力。© 2024 作者。 《联合欧洲胃肠病学杂志》由 Wiley periodicals LLC 代表联合欧洲胃肠病学出版。

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.© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.