Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2024; 30(12): 1727-1738
Published online Mar 28, 2024. doi: 10.3748/wjg.v30.i12.1727
Assessing recent recurrence after hepatectomy for hepatitis B-related hepatocellular carcinoma by a predictive model based on sarcopenia
Hong Peng, Si-Yi Lei, Wei Fan, Yu Dai, Yi Zhang, Gen Chen, Ting-Ting Xiong, Tian-Zhao Liu, Yue Huang, Xiao-Feng Wang, Jin-Hui Xu, Xin-Hua Luo
Hong Peng, Si-Yi Lei, Ting-Ting Xiong, Tian-Zhao Liu, Yue Huang, Xiao-Feng Wang, Jin-Hui Xu, Xin-Hua Luo, Department of Infectious Diseases, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Wei Fan, Yu Dai, Yi Zhang, Gen Chen, Department of Hepatobiliary Surgery, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Co-first authors: Hong Peng and Si-Yi Lei.
Author contributions: Peng H and Lei SY contributed equally to this work; Peng H and Lei SY conceptualized and designed the study; Fan W, Dai Y, Zhang Y and Chen G were the hepatobiliary surgery specialists; Fan W, Dai Y, Zhang Y and Chen G, Liu TZ and Xu JH acquired the data; Lei SY and Huang Y analyzed and interpreted the data; Xiong TT, Wang XF and Luo XH provided fund support; Lei SY drafted the manuscript; Peng H and Luo XH critically revised the manuscript for important intellectual content; Peng H , Fan W, Zhang Y and Luo XH provided administrative, technical, or material support; Peng H and Luo XH supervised the study. All authors made a significant contribution to this study and approved the final manuscript.
Supported by Guizhou Provincial Science and Technology Projects, No. [2021]013 and No. [2021]053; and Doctor Foundation of Guizhou Provincial People's Hospital, No. GZSYBS[2021]07.
Institutional review board statement: The 1975 Declaration of Helsinki's ethical principles were followed by the research design. The ethics committee of the Guizhou Provincial People's Hospital authorized the investigation, which attests to this (Approval No: 2023-009).
Informed consent statement: Due to the study's retrospective character, an exemption from the informed consent criteria was authorized.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during and analyzed during the current study are not publicly available due to participant privacy issues but are available from the corresponding author at Luoxinhua1972@126.com upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Hua Luo, PhD, Chief Doctor, Department of Infectious Diseases, Guizhou Provincial People’s Hospital, No. 83 Zhongshan East Road, Nanming District, Guiyang 550002, Guizhou Province, China. luoxinhua1972@126.com
Received: November 27, 2023
Peer-review started: November 27, 2023
First decision: January 17, 2024
Revised: January 30, 2024
Accepted: March 13, 2024
Article in press: March 13, 2024
Published online: March 28, 2024
Processing time: 121 Days and 22.1 Hours
ARTICLE HIGHLIGHTS
Research background

The recurrence of hepatocellular carcinoma (HCC) has a significant impact on the survival outcomes of patients, and early prediction and intervention can help improve patient survival outcomes. Nutritional factors have always been a hot topic of concern and are prone to intervention.

Research motivation

Sarcopenia is one of the effective indicators for evaluating nutritional status in chronic liver disease, which was reported that sarcopenia as a negative prognostic factor in patients with HCC. Hence, it is necessary to incorporate them into models for predicting early recurrence of HCC to screen out high-risk groups, as they may require more aggressive intervention.

Research objectives

This study aimed to construct a nutrition-based model to estimate recurrence-free survival (RFS) after hepatectomy for hepatitis B-related HCC based on sarcopenia.

Research methods

According to the inclusion and exclusion criteria, 283 patients with hepatitis B-related HCC were eventually enrolled in this retrospective study: 189 patients in the training cohort and 94 patients in the validation cohort. Skeletal muscle index at the third lumbar spine was evaluated according to abdominal computed tomography scans before hepatectomy. Independent predictors of disease recrudescence were evaluated with univariate and multivariate Cox proportional hazard models in training cohort, and A nomogram model was developed to predict the RFS of HCC patients. Its predictive performance was validated in the validation cohort. Furthermore, we compared the predictive model with other preoperative models and assessed their prognostic values by analyzing the time-dependent area under the receiver operating characteristic curve (tdAUROC).

Research results

Our data demonstrated that among 144 (50.9%) patients developed recurrence within 2 years after hepatectomy, and the median RFS was 7.67 months (95%CI: 6.59-8.75). Multivariate analysis showed that sarcopenia, alpha-fetoprotein ≥ 40 ng/mL, the maximum diameter of tumor > 5 cm, and hepatitis B virus DNA level ≥ 2000 IU/ mL were independent risk factors associated with postoperative recurrence of HCC. The SAMD model predicting the RFS of HCC patients was established based on the above factors. The area under the curve of the SAMD model was 0.782 (95%CI: 0.705-0.858) in the training cohort (sensitivity 81%, specifcity 63%) and 0.773 (95%CI: 0.707-0.838) in the validation cohort. Besides, a SAMD score ≥ 110 was better to distinguish the high-risk group of postoperative recurrence of HCC compared to other models. Further multicenter studies are warranted to validate our findings.

Research conclusions

Our study highlights the strong correlation between sarcopenia and recent recurrence after hepatectomy for hepatitis B-related HCC. A predictive model based on sarcopenia for assessing recent recurrence after liver resection for hepatitis B-associated hepatocellular carcinoma was developed for the first time.

Research perspectives

The SAMD model based on sarcopenia has favorable performance in predicting RFS in patients undergoing hepatectomy for hepatitis B-related HCC. It is helpful for the comprehensive clinical intervention in such patients. In the future, we need to further validate and apply this model, and conduct prospective studies to explore the impact of nutritional interventions on patient survival outcomes.