Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor

Yusheng Guo; Yanqiao Ren; Feihong Wu; Xiangjun Dong; Chuansheng Zheng

doi:10.1177/17562848221142417

Prognostic impact of sarcopenia in patients with hepatocellular carcinoma treated with PD-1 inhibitor

Therap Adv Gastroenterol. 2022 Dec 26:15:17562848221142417. doi: 10.1177/17562848221142417. eCollection 2022.

Authors

Yusheng Guo^{1

2}, Yanqiao Ren^{1

2}, Feihong Wu^{1

2}, Xiangjun Dong^{3

2}, Chuansheng Zheng^{3

2}

Affiliations

¹ Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
³ Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei 430022, China.

Abstract

Background: Sarcopenia is a progressive generalized loss of skeletal muscle mass commonly observed in advanced stages of cancer.

Objective: To assess the relationship between sarcopenia and the prognosis of patients with hepatocellular carcinoma (HCC) treated with a programmed cell death 1 (PD-1) inhibitor.

Design: This is a retrospective study.

Methods: This study included patients with HCC treated with camrelizumab between 1 March 2020 and 1 December 2021. The skeletal muscle area at the L3 vertebra middle level was used to calculate the skeletal muscle index. Propensity score matching (PSM) analysis was used to balance the variables between the two groups.

Results: In all, 97 patients with HCC were included in the study, with 46 and 51 patients in the sarcopenia group and the non-sarcopenia group, respectively. The baseline characteristics of albumin, Child-Pugh class, albumin-bilirubin score, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were significantly different between the two groups. In total, 26 patients from each group (n = 52) were selected after the PSM analysis. The progression-free survival (PFS) in the non-sarcopenia group was significantly longer than that in the sarcopenia group before and after PSM analysis (6.5 versus 4.8 months, p = 0.038). In addition, the disease control rate was similar before and after PSM analysis (57.7% versus 69.2%, p = 0.388). The objective response rate in the non-sarcopenia group tended to be higher than that in the sarcopenia group (11.5% versus 30.8%, p = 0.090, after PSM), but no statistically significant difference was found. The median overall survival (OS) in the non-sarcopenia group tended to longer than it in the sarcopenia group before PSM without significant differences (16.3 versus 11.3 months, p = 0.090) and the median OS was similar between the two groups after PSM (16.3 versus 16.8 months, p = 0.735).

Conclusions: HCC patients with sarcopenia tended to have higher levels of inflammation and lower levels of albumin than patients without sarcopenia. Sarcopenia is associated with a shorter PFS in HCC patients treated with PD-1 inhibitor.

Keywords: hepatocellular carcinoma; immune checkpoint inhibitor; immunotherapy; programmed cell death 1 inhibitor; sarcopenia; skeletal muscle index.