Sarcopenia and myosteatosis are associated with low survival in patients receiving lenvatinib for unresectable hepatocellular carcinoma

Pei-Jui Luo; Kai-I Chuang; Cheng-Fu Ni; Hsiao-Yu Yeh; Ming-Shun Wu; Yao-Yu Hsieh; Wei-Yu Kao; Chih-Horng Wu

doi:10.1016/j.jfma.2025.01.001

Sarcopenia and myosteatosis are associated with low survival in patients receiving lenvatinib for unresectable hepatocellular carcinoma

J Formos Med Assoc. 2025 Jan 9:S0929-6646(25)00001-4. doi: 10.1016/j.jfma.2025.01.001. Online ahead of print.

Authors

Pei-Jui Luo¹, Kai-I Chuang², Cheng-Fu Ni², Hsiao-Yu Yeh³, Ming-Shun Wu⁴, Yao-Yu Hsieh⁵, Wei-Yu Kao⁶, Chih-Horng Wu⁷

Affiliations

¹ Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan.
² Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.
³ Center of Minimal-Invasive Interventional Radiology, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Division of Hematology and Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan. Electronic address: [email protected].
⁷ Department of Medical Imaging and Radiology, National Taiwan University Hospital and College of Medicine, Taiwan; Center of Minimal-Invasive Interventional Radiology, National Taiwan University Hospital, Taipei, Taiwan; Hepatits Research Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: [email protected].

PMID: 39794175
DOI: 10.1016/j.jfma.2025.01.001

Abstract

Purpose: To investigate the association of skeletal muscle mass and quality with survival outcomes in patients with advanced hepatocellular carcinoma (HCC) treated with lenvatinib (LEN).

Methods: In this retrospective study, LEN-treated patients with HCC were enrolled. Sarcopenia and myosteatosis were evaluated on the basis of baseline skeletal muscle index and mean muscle attenuation, respectively, on computed tomography at the L3 level. Low skeletal muscle mass (LSMM) was determined on the basis of index value, and bioinformatics tools were used to determine reliable cutoff values. Myosteatosis was defined on the basis of mean Hounsfield unit values and predefined cutoff values. A logrank test and Cox proportional hazards model were used to compare overall survival (OS) and progression-free survival (PFS).

Results: A total of 81 patients were included. Patients with LSMM exhibited significantly lower PFS (p = 0.003) and OS (p = 0.010) than did patients without LSMM. Patients with myosteatosis exhibited significantly lower PFS (p = 0.012) and OS (p < 0.001) than did patients without myosteatosis. In multivariate analysis adjusted for tumor extent and liver function reserve, LSMM and myosteatosis remained independent predictors of low PFS (p = 0.028, p = 0.031) and OS (p = 0.027, p = 0.001), respectively.

Conclusion: LSMM and myosteatosis are independent prognostic factors for PFS and OS in advanced patients with HCC who received LEN and may exert synergistic effects on these survival outcomes.

Keywords: Computed tomography; Hepatocellular carcinoma; Lenvatinib; Myosteatosis; Prognosis; Sarcopenia.