Published online Mar 28, 2024. doi: 10.3748/wjg.v30.i12.1727
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
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.
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.
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.
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).
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.
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.
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.