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Sarcopenia is a prognostic outcome marker in children with high-risk hepatoblastoma
Annika Ritz1, Julian Kolorz1, Jochen Hubertus1
1Department of Pediatric Surgery, Research Laboratories, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.
Insights
Children with hepatoblastoma often have sarcopenia before surgery, indicated by low muscle mass. This muscle loss is linked to a higher risk of disease relapse, especially in high-risk cases.
Area of Science:
- Pediatric Oncology
- Sarcopenia Research
- Muscle Physiology
Background:
- Hepatoblastoma (HB) in children increases risk of sarcopenia due to immobility, chemotherapy, and malnutrition.
- Sarcopenia, characterized by low muscle mass, may negatively impact treatment outcomes in pediatric cancer patients.
- Preoperative low total psoas muscle area (tPMA) is hypothesized as a marker for sarcopenia in children with HB.
Purpose of the Study:
- To investigate the prevalence of sarcopenia in children with hepatoblastoma before surgery.
- To determine the association between preoperative sarcopenia and disease relapse in hepatoblastoma patients.
- To assess the relationship between muscle mass and other clinical variables in pediatric HB.
Main Methods:
- Retrospective analysis of 33 children (1-10 years) with hepatoblastoma treated between 2009-2018.
- Measurement of total psoas muscle area (tPMA) from CT scans at L3-L4 and L4-L5 intervertebral levels.
- Calculation of tPMA z-scores using age- and gender-specific references; sarcopenia defined as z-score < -2.
Main Results:
- 52% of children with hepatoblastoma were identified as sarcopenic preoperatively (mean tPMA z-score: -2.18 ± 1.08).
- A weak correlation was observed between tPMA and weight (r=0.35, P=0.045), with most children having normal weight z-scores.
- All 5 high-risk relapsed patients were sarcopenic preoperatively, and relapse was significantly higher in sarcopenic versus non-sarcopenic groups (P=0.008).
Conclusions:
- The majority of children with hepatoblastoma exhibit preoperative sarcopenia.
- Sarcopenia is an independent risk factor for relapse in high-risk hepatoblastoma patients.
- Further multicenter studies are warranted to validate these findings and explore interventions.
Background:
Children with hepatoblastoma (HB) are at risk of sarcopenia due to immobility, chemotherapy, and malnutrition. We hypothesized that children with HB have a low preoperative total psoas muscle area (tPMA), reflecting sarcopenia, which negatively impacts outcome.
Procedure:
Retrospective study of children (1-10 years) with hepatoblastoma treated at a large university children's hospital from 2009 to 2018. tPMA was measured as the sum of the right and left psoas muscle area (PMA) at intervertebral disc levels L3-4 and L4-5. z-Scores were calculated using age- and gender-specific reference values and were compared to anthropometric measurements, clinical variables, and outcomes. Sarcopenia was defined as a tPMA z-score below -2.
Results:
Thirty-three children were included. Mean tPMA z-score was -2.18 ± 1.08, and 52% were sarcopenic. A poor correlation between tPMA and weight was seen (r = 0.35; confidence interval [CI] 0.01, 0.62; P = .045), and most children had weights within the normal range (mean z-score -0.55 ± 1.39). All children categorized as high risk with relapse (n = 5/12) were sarcopenic before surgery. Relapse was significantly higher in the high-risk sarcopenic group compared to the nonsarcopenic group (P = .008). The change in tPMA z-score 1-4 months after surgery did not improve in patients with relapse, but did improve in 75% of children without relapse.
Conclusions:
The majority of children with HB were sarcopenic prior to surgery. Especially in children with high-risk hepatoblastoma, sarcopenia is an additional risk factor for relapse. Large multicenter studies are needed to confirm these preliminary results.
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