Sarcopenia impairs survival and treatment efficacy in patients with hepatocellular carcinoma undergoing immunotherapy

Background Sarcopenia is a common problem in patients with cirrhosis and hepatocellular carcinoma (HCC) and frequently impairs their clinical course. The impact of sarcopenia on survival and treatment efficacy in HCC patients undergoing immunotherapy has yet to be evaluated.

Materials and Methods Patients with HCC treated with PD-(L)1-based immunotherapy between June 2016 and October 2021 at the Medical University of Vienna were included. Sarcopenia was defined by transversal psoas muscle thickness (TPMT) at<12 mm/m in men and<8 mm/m in women at the level of the third lumbar vertebrae using cross-sectional imaging (CT/MRI) at baseline. We investigated the impact of sarcopenia on radiological response (mRECIST) as well as time-to-progression (TTP), progression-free survival (PFS) and overall survival (OS).

Results TPMT was evaluated at a median of 20 (IQR 0-38) days prior to first immunotherapy infusion and sarcopenia was present in 37/83 (45%) patients. Sarcopenia at baseline was much more prevalent in men (53%) compared to women (19%, p=0.006). The presence of sarcopenia was not only associated with a worse radiological response (evaluable in 68 patients): complete/partial response (CR/PR): 11.5% vs. 35.7%, stable disease (SD): 30.8% vs. 40.5, progressive disease (PD): 57.7% vs. 23.8% (p=0.011), but also with a worse outcome: time-to-progression (TTP, evaluable in 68 patients): 2.5 (95%CI: 1.9-3.1) vs. 10.4 (95%CI: 8.7-12.1) months (p=0.010); progression-free survival (PFS): 2.3 (95%CI: 1.8-2.7) vs. 9.2 (95%CI: 2.5-15.9) months (p=0.002); overall survival (OS): 5.3 (95%CI: 2.5-8.0) vs. 22.6 (95%CI: 8.6-36.6) months (p=0.012). Even after multivariable adjustment for baseline Child-Pugh stage, ECOG PS, presence of macrovascular invasion or extrahepatic metastasis and baseline AFP levels, sarcopenia (aHR: 2.3, 95%CI: 1.2-4.5) remained an independent predictor of survival.

Conclusions The presence of sarcopenia as determined by TPMT measurement prior to treatment initiation is associated with a significantly impaired survival and treatment efficacy in HCC patients undergoing immunotherapy.

Publication History

Article published online:
26 August 2022