Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions

Area of Science:

• Hepatology
• Oncology
• Geriatrics

Background:

• Hepatocellular carcinoma (HCC) is a major global health concern, ranking as the second most common cancer and a leading cause of cancer-related death.
• Sarcopenia, characterized by early muscle mass loss, is prevalent in HCC and impacts patient prognosis.
• Existing prognostic systems for HCC have limitations, particularly in evaluating patient performance status.

Purpose of the Study:

• To review current knowledge on sarcopenia in cirrhosis, with a specific focus on its role in hepatocellular carcinoma (HCC).
• To examine the predictive value of sarcopenia for clinical outcomes and prognostication in HCC patients undergoing various treatments.
• To explore the potential of sarcopenia measurement to enhance existing HCC prognostic systems.

Main Methods:

• A comprehensive literature review was conducted using major scientific databases (PubMed/MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL) up to April 1, 2021.
• The review focused on identifying published reports concerning sarcopenia in the context of HCC and its impact on treatment outcomes.
• Analysis included evaluating sarcopenia's role in predicting mortality and its potential as an adjunct to established scoring systems.

Main Results:

• Sarcopenia is an independent predictor of HCC-related mortality, particularly in patients receiving loco-regional therapies, liver transplantation, or systemic treatments.
• Early identification of sarcopenia offers opportunities to improve muscle health and potentially enhance prognosis before initiating treatment.
• Sarcopenia measurement can provide a more accurate assessment of patient status, overcoming limitations posed by factors like abdominal ascites.

Conclusions:

• Sarcopenia is a significant prognostic factor in HCC, offering valuable insights beyond traditional scoring systems.
• Early intervention targeting sarcopenia in HCC patients may lead to improved clinical outcomes and survival rates.
• Integrating sarcopenia assessment into clinical practice can refine prognostication and guide treatment strategies for HCC.