Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2024; 30(12): 1727-1738
Published online Mar 28, 2024. doi: 10.3748/wjg.v30.i12.1727
Assessing recent recurrence after hepatectomy for hepatitis B-related hepatocellular carcinoma by a predictive model based on sarcopenia
Hong Peng, Si-Yi Lei, Wei Fan, Yu Dai, Yi Zhang, Gen Chen, Ting-Ting Xiong, Tian-Zhao Liu, Yue Huang, Xiao-Feng Wang, Jin-Hui Xu, Xin-Hua Luo
Hong Peng, Si-Yi Lei, Ting-Ting Xiong, Tian-Zhao Liu, Yue Huang, Xiao-Feng Wang, Jin-Hui Xu, Xin-Hua Luo, Department of Infectious Diseases, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Wei Fan, Yu Dai, Yi Zhang, Gen Chen, Department of Hepatobiliary Surgery, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China
Co-first authors: Hong Peng and Si-Yi Lei.
Author contributions: Peng H and Lei SY contributed equally to this work; Peng H and Lei SY conceptualized and designed the study; Fan W, Dai Y, Zhang Y and Chen G were the hepatobiliary surgery specialists; Fan W, Dai Y, Zhang Y and Chen G, Liu TZ and Xu JH acquired the data; Lei SY and Huang Y analyzed and interpreted the data; Xiong TT, Wang XF and Luo XH provided fund support; Lei SY drafted the manuscript; Peng H and Luo XH critically revised the manuscript for important intellectual content; Peng H , Fan W, Zhang Y and Luo XH provided administrative, technical, or material support; Peng H and Luo XH supervised the study. All authors made a significant contribution to this study and approved the final manuscript.
Supported by Guizhou Provincial Science and Technology Projects, No. [2021]013 and No. [2021]053; and Doctor Foundation of Guizhou Provincial People's Hospital, No. GZSYBS[2021]07.
Institutional review board statement: The 1975 Declaration of Helsinki's ethical principles were followed by the research design. The ethics committee of the Guizhou Provincial People's Hospital authorized the investigation, which attests to this (Approval No: 2023-009).
Informed consent statement: Due to the study's retrospective character, an exemption from the informed consent criteria was authorized.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during and analyzed during the current study are not publicly available due to participant privacy issues but are available from the corresponding author at Luoxinhua1972@126.com upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Hua Luo, PhD, Chief Doctor, Department of Infectious Diseases, Guizhou Provincial People’s Hospital, No. 83 Zhongshan East Road, Nanming District, Guiyang 550002, Guizhou Province, China. luoxinhua1972@126.com
Received: November 27, 2023
Peer-review started: November 27, 2023
First decision: January 17, 2024
Revised: January 30, 2024
Accepted: March 13, 2024
Article in press: March 13, 2024
Published online: March 28, 2024
Abstract
BACKGROUND

Sarcopenia may be associated with hepatocellular carcinoma (HCC) following hepatectomy. But traditional single clinical variables are still insufficient to predict recurrence. We still lack effective prediction models for recent recurrence (time to recurrence < 2 years) after hepatectomy for HCC.

AIM

To establish an interventable prediction model to estimate recurrence-free survival (RFS) after hepatectomy for HCC based on sarcopenia.

METHODS

We retrospectively analyzed 283 hepatitis B-related HCC patients who underwent curative hepatectomy for the first time, and the skeletal muscle index at the third lumbar spine was measured by preoperative computed tomography. 94 of these patients were enrolled for external validation. Cox multivariate analysis was per-formed to identify the risk factors of postoperative recurrence in training cohort. A nomogram model was developed to predict the RFS of HCC patients, and its predictive performance was validated. The predictive efficacy of this model was evaluated using the receiver operating characteristic curve.

RESULTS

Multivariate analysis showed that sarcopenia [Hazard ratio(HR) = 1.767, 95%CI: 1.166-2.678, P < 0.05], alpha-fetoprotein ≥ 40 ng/mL (HR = 1.984, 95%CI: 1.307-3.011, P < 0.05), the maximum diameter of tumor > 5 cm (HR = 2.222, 95%CI: 1.285-3.842, P < 0.05), and hepatitis B virus DNA level ≥ 2000 IU/mL (HR = 2.1, 95%CI: 1.407-3.135, P < 0.05) were independent risk factors associated with postoperative recurrence of HCC. Based on the sarcopenia to assess the RFS model of hepatectomy with hepatitis B-related liver cancer disease (SAMD) was established combined with other the above risk factors. The area under the curve of the SAMD model was 0.782 (95%CI: 0.705-0.858) in the training cohort (sensitivity 81%, specificity 63%) and 0.773 (95%CI: 0.707-0.838) in the validation cohort. Besides, a SAMD score ≥ 110 was better to distinguish the high-risk group of postoperative recurrence of HCC.

CONCLUSION

Sarcopenia is associated with recent recurrence after hepatectomy for hepatitis B-related HCC. A nutritional status-based prediction model is first established for postoperative recurrence of hepatitis B-related HCC, which is superior to other models and contributes to prognosis prediction.

Keywords: Alpha-fetoprotein, Hepatitis B virus, Hepatectomy, Hepatocellular carcinoma, Nomogram, Predictive models, Recurrence, Recurrence-free survival, Risk factors, Sarcopenia

Core Tip: Our focus on the factors that can intervene or improve the adverse outcomes of postoperative recurrence in patients with hepatitis B-related hepatocellular carcinoma (HCC) and establish a more effective model for predicting recurrence. Our study found Sarcopenia is remarkably associated with recent recurrence after hepatectomy for hepatitis B-related HCC. The SAMD model based on sarcopenia established in this study emphasizes the assessment and monitor of sarcopenia in hepatitis B-related HCC patients and effectively assists clinicians in closely to identify and monitor high-risk populations to improve the recurrence outcome of hepatitis B-related HCC patients after surgery through multi angle intervention measures.