Purpose
The purpose of this study was to demonstrate the prognostic significance of changes in body composition in patients with newly diagnosed hepatocellular carcinoma (HCC).
Materials and Methods
Patients (n=178) newly diagnosed with HCC participated in the study between 2007 and 2012. Areas of skeletal muscle and abdominal fat were directly measured using a three-dimensional workstation. Cox proportional-hazards modes were used to estimate the effect of baseline variables on overall survival. The inverse probability of treatmentweighting (IPTW) method was used to minimize confounding bias.
Results
Cutoff values for sarcopenia, obtained from receiver-operating characteristic curves, were defined as skeletal muscle index at the third lumbar vertebra of ≤ 45.8 cm/m2 for males and ≤ 43.0 cm/m2 for females. Sarcopenia patients were older, more likely to be female, and had lower body mass index. Univariable analysis showed that the presence of sarcopenia and visceral to subcutaneous fat area ratio (VSR) were significantly associatedwith prognosis. The multivariable analyses revealed that VSR was predictive of overall survival. However, in the multivariable Cox model adjusted by IPTW, sarcopenia, not VSR, were associated with overall survival.
Conclusion
The presence of sarcopenia at HCC diagnosis is independently associated with survival.
Citations
Citations to this article as recorded by
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Background The biliary stents in current use have a tendency to be blocked. In order to maintain long-term patency of stent a larger diameter of biliary stent is needed and the expandable metal stents(EMS) have been developed. But tumor ingrowth was frequently observed in uncovered self-EMS. To overcome the limitations of uncovered self-EMSs, we developed self-EMS covered with polyurethane or polytetrafluoroethylene(PTFE) which was used as artificial vessel. This stent would have more advantages than uncovered self- EMS. Aim: To evaluate the successfulness and the effectiveness of new membrane covered self-EMS(covered modified-Gianturco biliary stent) with polyurethane or PTFE, we studied in patients with malignant biliary obstruction due to biliopancreatic carcinoma. Methods: We developed self-EMS covered with polyurethane or PTFE, and applied covered self-EMS through endoscopic transpapillary or percutaneous transhepatic route in l8 patients of malignant biliary obstruction and 2 benign stricture. We followed-up the patients monthiy with ultrasonography, clinical symptoms and liver function test. There were 13 men and 7 women. The mean age in inrolled patients was 65.6¡¾7.9 year. 10 had CBD cancer, 7 pancreatic head cancer, 1 ampulla of Vater cancer, and 2 benign intrahepatic bile duct stricture. Results: The success rate of covered self-EMS insertion through peroral transpapillary route was 84.6%(11/13) on first trial. In 2 patients with malignant biliary obstruction we couldn't insert covered self-EMS because of technical problems in introducing system, but sucessfully inserted on second trial. And through the Percutaneous transhepatic route, we could also sucessfully applied covered self-EMS in all patients(7/7). There were no complications associated to the procedure of stent implantation. In one case the stent was dislodged spontaneously after 1.3 month, and one patient died after 1 month due to pulmonary metastasis. There was no evidence of biliary reobstruction during follow-up period d[median follow-up 6.75(l.312) months in PTFE patients(4) and 2(l 10) months in polyurethane patients(16)]. Conclusion: We expect that new membrane covered self-EMS has long-term patency and adequacy of biliary drainage, but we cannot completely evaluate the disadvantage of this stent until now due to short-term follow up.