Published online Jul 27, 2022. doi: 10.4254/wjh.v14.i7.1480
Peer-review started: February 25, 2022
First decision: April 8, 2022
Revised: April 20, 2022
Accepted: June 22, 2022
Article in press: June 22, 2022
Published online: July 27, 2022
Processing time: 152 Days and 7.8 Hours
Hepatocellular carcinoma (HCC) is prone to recurrence, even if cured at an early stage. In recent years, many studies have demonstrated that sarcopenia is a poor prognostic factor in patients with chronic liver disease and HCC, because it is related to frailty, loss of function, and low quality of life. Pre-sarcopenia is defined as muscle volume loss without muscle power loss and is a poor prognostic factor in the elderly population. In addition, the usefulness of the Mac-2 binding protein glycosylation isomer (M2BPGi), or Wisteria floribunda agglutinin-positive M2BP, which was first reported as a fibrosis marker in hepatitis C virus (HCV) patients, to treat HCC has recently attracted attention.
The M2BPGi, a fibrosis marker in various liver diseases, is reportedly a prognostic marker in patients with HCC who underwent hepatectomy. In recent years, many studies have demonstrated that sarcopenia is a poor prognostic factor in patients with chronic liver disease and HCC, because it is related to frailty, loss of function, and low quality of life. Sarcopenia is diagnosed using both muscle power loss and muscle volume loss. Pre-sarcopenia is defined as muscle volume loss without muscle power loss and is a poor prognostic factor in the elderly population.
To investigate the usefulness of pre-sarcopenia, M2BPGi, and M2BP as recurrence and prognostic factors in patients who underwent RFA for early-stage HCC.
In this study, 202 patients underwent radiofrequency ablation (RFA) for primary HCCs. Of these, 160 cases were classified as BCLC stage 0 or A, and the data were analyzed. Eighty-three patients were classified into the HCV-positive group, and 77 patients were classified into the HCV-negative group.
In HCV-positive patients, only des-γ-carboxy-prothrombin (DCP) ≥ 23 mAU/mL was a significant poor prognostic factor affecting survival after RFA. In HCV-negative patients, M2BPGi ≥ 1.86 cutoff index was significantly associated with tumor recurrence, but M2BP was not. M2BPGi ≥ 1.86 cutoff index (hazard ratio, 4.89; 95% confidence interval: 1.97-12.18; P < 0.001) and pre-sarcopenia (hazard ratio, 3.34, 95% confidence interval: 1.19-9.37; P = 0.022) were independent significant poor prognostic factors in HCV-negative patients.
In HCV-negative patients with primary HCC treated with RFA, lower M2BPGi contributed to a lower tumor recurrence rate and longer survival period. Pre-sarcopenia contributed to the poor prognosis independently in HCV-negative patients.
In the near future, almost all HCVs will be eradicated by DAA treatment. Almost no HCC cases were derived from the current HCV infection. Pre-sarcopenia and M2BPGi, but not M2BP, might be useful tools to predict survival in early-stage HCC in the era of HCV eradication.