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.
引言：肝细胞癌（HCC）是全球重大健康问题，其病因模式不断演变，治疗方案多样。在众多预后因素中，以骨骼肌质量、力量和功能丧失为特征的肌肉减少症已成为影响HCC预后的关键因素。本综述聚焦肝移植、手术切除、局部治疗和系统治疗，旨在分析肌肉减少症对HCC治疗结局的影响，为探索更个体化的治疗方案提供新视角。 方法：通过系统检索截至2023年10月发表的关于HCC患者肌肉减少症与治疗结局的同行评议文献进行综合分析。 结果：研究发现肌肉减少症在HCC患者中普遍存在，其发生率因诊断标准差异而有所不同。值得注意的是，尽管各研究采用的骨骼肌指数存在差异，但肌肉减少症与外科治疗（移植与切除）、局部治疗及系统治疗（包括酪氨酸激酶抑制剂和免疫检查点抑制剂）患者的总生存期、无复发生存期和无进展生存期降低均存在独立相关性。此外，研究还观察到肌肉减少症与不良事件发生率及严重程度增加（尤其在手术和酪氨酸激酶抑制剂治疗患者中）以及诊断时肿瘤体积更大存在关联。虽然基线肌肉减少症对治疗结局产生负面影响，但治疗后肌肉质量的变化成为总生存期降低的主要决定因素。 结论：无论病因和治疗策略如何，HCC治疗前或治疗后出现的肌肉减少症均与治疗反应呈负相关。尽管目前仅有少数研究评估了监督性体能训练对HCC治疗后肌肉质量和总生存期的影响，但在治疗开始前评估肌肉减少症的存在至关重要，这有助于更精准地分层患者预后、实施个体化治疗方案，并探索能够恢复HCC患者肌肉质量的治疗方法。相反，肌肉减少症对HCC复发和肝外转移的影响仍需进一步研究。
The Negative Impact of Sarcopenia on Hepatocellular Carcinoma Treatment Outcomes
肿瘤(癌症)患者之家