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Impact of muscle volume and muscle function decline in patients undergoing surgical resection for hepatocellular carcinoma
Author(s) -
Hiraoka Atsushi,
Otsuka Yasuhiro,
Kawasaki Hideki,
Izumoto Hirofumi,
Ueki Hidetaro,
Kitahata Shogo,
Aibiki Toshihiko,
Okudaira Tomonari,
Yamago Hiroka,
Miyamoto Yuji,
Iwasaki Ryuichiro,
Tomida Hideomi,
Mori Kenichiro,
Miyata Hideki,
Tsubouchi Eiji,
Kishida Masato,
Hirooka Masashi,
Abe Masanori,
Matsuura Bunzo,
Ninomiya Tomoyuki,
Mori Izumi,
Hiasa Yoichi,
Michitaka Kojiro
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14058
Subject(s) - medicine , hazard ratio , hepatocellular carcinoma , confidence interval , gastroenterology , spirometry , survival rate , proportional hazards model , carcinoma , surgery , asthma
Background and Aim This study investigated the prognostic impact of muscle volume loss (MVL) and muscle function decline in patients undergoing resection for hepatocellular carcinoma (HCC). Methods This study enrolled 171 naïve HCC patients treated with resection from 2007 to 2015, after excluding those lacking spirometry or computed tomography findings, who had received non‐curative treatments, or with restrictive or obstructive lung disorders. The median peak expiratory flow rate (%PEF) was set as the cut‐off value for muscle function decline, and MVL was diagnosed using a previously reported value. Clinical backgrounds and prognosis were retrospectively evaluated. Results Overall survival rate was lower in the MVL ( n = 35) as compared with the non‐MVL ( n = 136) group (1/3/5‐year overall survival rate = 88.2%/81.6%/55.6% vs 91.0%/81.5%/74.8%, respectively; P = 0.0083), while there were no differences regarding hepatic function or tumor burden between the groups. Child‐Pugh class B (hazard ratio [HR] 3.510, 95% confidence interval [CI]: 1.558–7.926, P = 0.0025), beyond Milan criteria (HR 1.866, 95%CI: 1.024–3.403, P = 0.042), and presence of MVL (HR 1.896, 95%CI: 1.052–3.416, P = 0.033) were significant prognostic factors. The decreased %PEF group ( n = 84) showed a higher rate of postoperative delirium than the others ( n = 87) (27.4% vs 11.5%, P = 0.0088). The cut‐off values for %PEF and age for postoperative delirium were 63.3% (area under receiver operating characteristic [AUROC] 0.697) and 73 years old (AUROC 0.734), respectively. Delirium was observed in 50.0% (14/28) of patients with both factors, 23.8% (15/63) of those with 1 factor, and 5.0% (4/80) of those without either factor. Conclusion Muscle volume loss is an independent prognostic factor in HCC patients treated with surgical resection, while advanced age and decreased muscle function might indicate high risk for postoperative delirium.