BACKGROUND: Osteopenia, loss of bone mineral density (BMD), was recently identified to be independently associated with early marker of deconditioning that precedes sarcopenia in patients with hepatocellular carcinoma (HCC). The aim of this study was to clarify the impact of osteopenia as the risk factor for mortality after living donor liver transplantation (LDLT) compared with already-reported biological markers. METHODS: Data were collected retrospectively for all consecutive patients who underwent LDLT for HCC at our institution between January 1998 and December 2015. BMD was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. Data related to clinicopathological parameters and prognosis were analyzed. RESULTS: The median value of BMD was 163.6 Hounsfield units and osteopenia was identified in 103 (53.4%) of the 193 recipients, according to the age-specific formula. In addition to the other tumor burdens, such as tumor numbers ≥5 (HR 2.521, P = 0.027), DCP levels >200 mAU/mL (HR 2.678, P = 0.006), and neutrophil-to-lymphocyte ratio ≥3.01 (HR 2.068, P = 0.025), osteopenia (HR 2.106, P = 0.024) was independent risk factor for mortality by multivariate analysis. Overall survival of the patients who met the two risk factors and more was significantly lower than the others (HR 5.382, P < 0.001). Besides, the calibration plot for the 5-year overall survival using nomogram was predicted very well (C-index 0.746). CONCLUSIONS: Preoperative osteopenia was independently associated with post-LDLT mortality among patients with HCC. Moreover, risk score and nomogram with calibration curve were developed to confirm the clinical usefulness of osteopenia for post-LDLT patients.
BACKGROUND:Osteopenia, loss of bone mineral density (BMD), was recently identified to be independently associated with early marker of deconditioning that precedes sarcopenia in patients with hepatocellular carcinoma (HCC). The aim of this study was to clarify the impact of osteopenia as the risk factor for mortality after living donor liver transplantation (LDLT) compared with already-reported biological markers. METHODS: Data were collected retrospectively for all consecutive patients who underwent LDLT for HCC at our institution between January 1998 and December 2015. BMD was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. Data related to clinicopathological parameters and prognosis were analyzed. RESULTS: The median value of BMD was 163.6 Hounsfield units and osteopenia was identified in 103 (53.4%) of the 193 recipients, according to the age-specific formula. In addition to the other tumor burdens, such as tumor numbers ≥5 (HR 2.521, P = 0.027), DCP levels >200 mAU/mL (HR 2.678, P = 0.006), and neutrophil-to-lymphocyte ratio ≥3.01 (HR 2.068, P = 0.025), osteopenia (HR 2.106, P = 0.024) was independent risk factor for mortality by multivariate analysis. Overall survival of the patients who met the two risk factors and more was significantly lower than the others (HR 5.382, P < 0.001). Besides, the calibration plot for the 5-year overall survival using nomogram was predicted very well (C-index 0.746). CONCLUSIONS:Preoperative osteopenia was independently associated with post-LDLT mortality among patients with HCC. Moreover, risk score and nomogram with calibration curve were developed to confirm the clinical usefulness of osteopenia for post-LDLT patients.
Authors: Pratima Sharma; Neehar D Parikh; Jessica Yu; Pranab Barman; Brian A Derstine; Christopher J Sonnenday; Stewart C Wang; Grace L Su Journal: Liver Transpl Date: 2016-06-29 Impact factor: 5.799
Authors: Kana Wu; Diane Feskanich; Charles S Fuchs; Walter C Willett; Bruce W Hollis; Edward L Giovannucci Journal: J Natl Cancer Inst Date: 2007-07-10 Impact factor: 13.506
Authors: Unnur Styrkarsdottir; Olafur A Stefansson; Kristbjorg Gunnarsdottir; Gudmar Thorleifsson; Sigrun H Lund; Lilja Stefansdottir; Kristinn Juliusson; Arna B Agustsdottir; Florian Zink; Gisli H Halldorsson; Erna V Ivarsdottir; Stefania Benonisdottir; Hakon Jonsson; Arnaldur Gylfason; Kristjan Norland; Katerina Trajanoska; Cindy G Boer; Lorraine Southam; Jason C S Leung; Nelson L S Tang; Timothy C Y Kwok; Jenny S W Lee; Suzanne C Ho; Inger Byrjalsen; Jacqueline R Center; Seung Hun Lee; Jung-Min Koh; L Stefan Lohmander; Lan T Ho-Pham; Tuan V Nguyen; John A Eisman; Jean Woo; Ping-C Leung; John Loughlin; Eleftheria Zeggini; Claus Christiansen; Fernando Rivadeneira; Joyce van Meurs; Andre G Uitterlinden; Brynjolfur Mogensen; Helgi Jonsson; Thorvaldur Ingvarsson; Gunnar Sigurdsson; Rafn Benediktsson; Patrick Sulem; Ingileif Jonsdottir; Gisli Masson; Hilma Holm; Gudmundur L Norddahl; Unnur Thorsteinsdottir; Daniel F Gudbjartsson; Kari Stefansson Journal: Nat Commun Date: 2019-05-03 Impact factor: 14.919