MRI-Derived Sarcopenia Associated with Increased Mortality Following Yttrium-90 Radioembolization of Hepatocellular Carcinoma

• Published in: Cardiovascular and interventional radiology 2021-10, Vol.44 (10), p.1561-1569
• Main Authors: Guichet, Phillip L., Taslakian, Bedros, Zhan, Chenyang, Aaltonen, Eric, Farquharson, Sean, Hickey, Ryan, Horn, Cash J., Gross, Jonathan S.
• Format: Article
• Language: English
• Subjects: Cardiology; Clinical Investigation; Hepatocellular carcinoma; Imaging; Interventional Oncology; Liver cancer; Magnetic resonance imaging; Medicine; Medicine & Public Health; Mortality; Muscles; Nuclear Medicine; Patients; Radiology; Sarcopenia; Survival; Ultrasound; Yttrium; Yttrium isotopes
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-021-02874-6

Purpose To evaluate the influence of sarcopenia on survival in patients with hepatocellular carcinoma (HCC) treated with 90 Y radioembolization. Materials and Methods This single-center retrospective cohort study analyzed 82 consecutive patients (65 men and 17 women, mean age 65 years, range 31–83 years) with HCC treated with 90 Y radioembolization between December 2013 and December 2017. Sarcopenia was assessed on pre-procedure MRI performed within 100 days prior to 90 Y radioembolization by segmenting the paraspinal musculature at the level of the superior mesenteric artery origin and subtracting fat-intensity pixels to yield fat-free muscle area (FFMA). Sarcopenia was defined as FFMA ≤31.97 cm 2 for men and ≤28.95 cm 2 for women. Survival at 90 days, 180 days, 1 year, and 3 years following initial treatment was assessed using medical and public obituary records. Results Sarcopenia was identified in 30% (25/82) of patients. Death was reported for 49% (32/65) of males and 71% (8/17) of females (mean follow-up 19.6 months, range 21 days–58 months). Patients with sarcopenia were found to have increased mortality at 180 days (31.8% vs. 8.9%) and 1 year (68.2% vs. 21.2%). Sarcopenia was an independent predictor of mortality adjusted for BCLC stage and sub-analysis demonstrated that sarcopenia independently predicted increased mortality for patients with BCLC stage B disease. Conclusion Sarcopenia was associated with increased 180-day and 1-year mortality in HCC patients undergoing 90 Y radioembolization. Sarcopenia was an independent predictor of survival adjusted for BCLC stage with significant deviation in the survival curves of BCLC stage B patients with and without sarcopenia.