Background: Sarcopenia, defined as the loss of skeletal muscle mass, physical performance, and strength, has been associated with poor clinical outcomes in hepatocellular carcinoma (HCC) patients treated with several therapies. As systemic therapies, including molecular targeted agents, have a strong impact on sarcopenia, we aimed to review the impact of sarcopenia in patients receiving systemic therapies, especially sorafenib and hepatic arterial infusion chemotherapy (HAIC). Summary: Several studies have demonstrated that sarcopenia is associated with poor clinical outcomes in patients receiving sorafenib or lenvatinib, while HAIC has no association with overall survival (OS) and sarcopenia. Furthermore, based on our previous study, we developed the management of sorafenib score (MS score) to stratify patients’ survival according to the positivity of three parameters (skeletal muscle mass, disease control of sorafenib, and post-sorafenib therapy), ranging from 0 to 3. Patients with an MS score ≥2 (median survival time [MST], 16.4 months) showed significantly longer survival than those with an MS score ≤1 (MST, 8.4 months) (p <0.001). This result indicates that patients need at least two positive parameters to prolong OS. Although performance status (PS) has been used in the Barcelona Clinic Liver Cancer staging system, we consider that the assessment of sarcopenia has the potential to replace PS. Key messages: Sarcopenia is associated with poor clinical outcomes in patients of hepatocellular carcinoma receiving sorafenib or lenvatinib. The management of sorafenib (MS) score, based on the positivity of three prognostic factors, including skeletal muscle mass, in patients receiving sorafenib, can be a reliable indicator of prolonged survival.


中文翻译：

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基于肌少症评估的晚期肝细胞癌患者的全身治疗和肝动脉灌注化疗管理


背景：肌肉减少症被定义为骨骼肌质量、身体机能和力量的丧失，与接受多种疗法治疗的肝细胞癌（HCC）患者临床结果不佳有关。由于包括分子靶向药物在内的全身治疗对肌肉减少症有很大影响，我们旨在回顾肌肉减少症对接受全身治疗（特别是索拉非尼和肝动脉灌注化疗（HAIC））患者的影响。摘要：多项研究表明，肌肉减少症与接受索拉非尼或乐伐替尼治疗的患者不良临床结果相关，而 HAIC 与总生存期 (OS) 和肌肉减少症无关。此外，基于我们之前的研究，我们开发了索拉非尼评分（MS评分）的管理，根据三个参数（骨骼肌质量、索拉非尼的疾病控制和索拉非尼治疗后）的积极性对患者的生存进行分层，范围从0 至 3。MS 评分 ≥2 的患者（中位生存时间 [MST]，16.4 个月）的生存期明显长于 MS 评分 ≤ 1 的患者（MST，8.4 个月）（p <0.001）。该结果表明患者至少需要两个积极参数才能延长 OS。尽管体能状态（PS）已用于巴塞罗那临床肝癌分期系统，但我们认为肌少症的评估有潜力取代PS。 关键信息：肌肉减少症与接受索拉非尼或乐伐替尼的肝细胞癌患者临床结局不佳有关。索拉非尼 (MS) 评分的管理基于接受索拉非尼治疗的患者三个预后因素（包括骨骼肌质量）的积极性，可以作为延长生存的可靠指标。