Martin Seror1, Riccardo Sartoris1,2, Christian Hobeika3, Mohamed Bouattour4, Valérie Paradis5,2, Pierre-Emmanuel Rautou4,2, Olivier Soubrane3, Valérie Vilgrain1,2, François Cauchy3,2, Maxime Ronot6,7. 1. Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France. 2. Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France. 3. Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France. 4. Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France. 5. Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France. 6. Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France. maxime.ronot@aphp.fr. 7. Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France. maxime.ronot@aphp.fr.
Abstract
OBJECTIVE: The aim of this study was to assess the prognostic value of liver surface nodularity (LSN) and sarcopenia from preoperative computed tomography (CT) in patients with resectable metabolic syndrome (MS)-related hepatocellular carcinoma (HCC). METHODS: Patients with MS undergoing hepatectomy for HCC between 2006 and 2018 at a single center were retrospectively analyzed. LSN and sarcopenia were assessed on preoperative CT scans, and their association with severe (Clavien-Dindo grade 3-5) postoperative complications was analyzed on multivariate analysis. The influence of LSN and sarcopenia on overall survival (OS) and recurrence-free survival (RFS) was assessed. RESULTS: Overall, 110 patients (92 men [84%], mean 67.7 ± 7.7 years of age) were analyzed. Severe postoperative complications occurred in 34/110 (31%) patients. Patients with severe complications had a significantly higher LSN score (area under the receiver operating characteristic curve 0.68 ± 0.05, optimal cut-off > 2.50) and were more frequently sarcopenic (47% vs. 13% without major complications, p < 0.001). Multivariate analysis identified sarcopenia (odds ratio [OR] 6.51, 95% confidence interval [CI] 2.08-20.39; p < 0.001), LSN > 2.50 (OR 7.05, 95% CI 2.13-23.35; p < 0.001), and preoperative portal vein embolization (PVE; OR 6.06, 95% CI 1.71-21.48; p = 0.005) as independent predictors of severe complications. LSN and sarcopenia had no influence on OS. Stratification according to a combination of LSN > 2.50 and sarcopenia predicted the risk of severe postoperative complications from 7% (no sarcopenia and LSN ≤2.50) to 71% (sarcopenia and LSN > 2.50; p < 0.001), as well as RFS from 61 months (95% CI 40-82) to 17 months (95% CI 9-25; p = 0.033). Results remained significant in 52 patients without advanced fibrosis. CONCLUSIONS: The combination of LSN and sarcopenia derived from routine preoperative CT seems to help predict severe postoperative complications and stratification of RFS in patients with MS and resectable HCC.
OBJECTIVE: The aim of this study was to assess the prognostic value of liver surface nodularity (LSN) and sarcopenia from preoperative computed tomography (CT) in patients with resectable metabolic syndrome (MS)-related hepatocellular carcinoma (HCC). METHODS:Patients with MS undergoing hepatectomy for HCC between 2006 and 2018 at a single center were retrospectively analyzed. LSN and sarcopenia were assessed on preoperative CT scans, and their association with severe (Clavien-Dindo grade 3-5) postoperative complications was analyzed on multivariate analysis. The influence of LSN and sarcopenia on overall survival (OS) and recurrence-free survival (RFS) was assessed. RESULTS: Overall, 110 patients (92 men [84%], mean 67.7 ± 7.7 years of age) were analyzed. Severe postoperative complications occurred in 34/110 (31%) patients. Patients with severe complications had a significantly higher LSN score (area under the receiver operating characteristic curve 0.68 ± 0.05, optimal cut-off > 2.50) and were more frequently sarcopenic (47% vs. 13% without major complications, p < 0.001). Multivariate analysis identified sarcopenia (odds ratio [OR] 6.51, 95% confidence interval [CI] 2.08-20.39; p < 0.001), LSN > 2.50 (OR 7.05, 95% CI 2.13-23.35; p < 0.001), and preoperative portal vein embolization (PVE; OR 6.06, 95% CI 1.71-21.48; p = 0.005) as independent predictors of severe complications. LSN and sarcopenia had no influence on OS. Stratification according to a combination of LSN > 2.50 and sarcopenia predicted the risk of severe postoperative complications from 7% (no sarcopenia and LSN ≤2.50) to 71% (sarcopenia and LSN > 2.50; p < 0.001), as well as RFS from 61 months (95% CI 40-82) to 17 months (95% CI 9-25; p = 0.033). Results remained significant in 52 patients without advanced fibrosis. CONCLUSIONS: The combination of LSN and sarcopenia derived from routine preoperative CT seems to help predict severe postoperative complications and stratification of RFS in patients with MS and resectable HCC.
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