Abstract
Background: Assessment of patient performance status is often subjective. Sarcopenia-measurement of muscle wasting-may be a more objective means to assess performance status and therefore mortality risk following intra-arterial therapy (IAT). Methods: Total psoas area (TPA) was measured on cross-sectional imaging in 216 patients undergoing IAT of hepatic malignancies between 2002 and 2012. Sarcopenia was defined as TPA in the lowest sex-specific quartile. Impact of sarcopenia was assessed relative to other clinicopathological factors. Results: Indications for IAT included hepatocellular carcinoma (51 %), intrahepatic cholangiocarcinoma (13 %), colorectal liver metastasis (7 %), or other metastatic disease (30 %). Median TPA among men (568 mm2/m2) was greater than women (413 mm2/m2). IAT involved conventional chemoembolization (54 %), drug-eluting beads (40 %), or yttrium-90 (6 %). Median tumor size was 5.8 cm; most patients had multiple lesions (74 %). Ninety-day mortality was 9.3 %; 3-year survival was 39 %. Factors associated with risk of death were tumor size (HR = 1.84) and Child's score (HR = 2.15) (all P < 0.05). On multivariate analysis, sarcopenia remained independently associated with increased risk of death (lowest vs. highest TPA quartile, HR = 1.84; P = 0.04). Sarcopenic patients had a 3-year survival of 28 vs. 44 % for non-sarcopenic patients. Conclusions: Sarcopenia was an independent predictor of mortality following IAT with sarcopenic patients having a twofold increased risk of death. Sarcopenia is an objective measure of frailty that can help clinical decision-making regarding IAT for hepatic malignancies.
Original language | English (US) |
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Pages (from-to) | 2123-2132 |
Number of pages | 10 |
Journal | Journal of Gastrointestinal Surgery |
Volume | 17 |
Issue number | 12 |
DOIs | |
State | Published - Dec 2013 |
Keywords
- Frailty
- Intra-arterial therapy
- Outcomes
- Performance status
- Sarcopenia
ASJC Scopus subject areas
- Surgery
- Gastroenterology