64 - Sarcopenia Identified with CT is Associated with Worse Treatment Response to Yttrium-90 Radioembolization in Hepatocellular Carcinoma

Monday, March 31, 2025

12:10 PM – 1:10 PM CT

Location: Music City Center, Expo Poster Area

Author/Co-author(s)

AE

Ali Eryurekli, MD

Attending Doctor
Gaziosmanpasa Training and Research Hospital, United States

Poster Presenter(s)

SK

Seyfullah H. Karagoz, MD (he/him/his)

Resident Doctor
Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Radiology Department, Turkey

Author/Co-author(s)

CS

Cesur Samanci, MD

Associate Professor
Istanbul University Cerrahpasa Medical Faculty, Turkey

Purpose: To investigate the effect of Computed tomography (CT) proven sarcopenia on treatment response and survival in hepatocellular carcinoma (HCC) patients treated with 90Y radioembolization.

Materials and Methods: 90 patients (70 men and 18 women, mean age 65.5 years) diagnosed with hepatocellular carcinoma, BCLC stage B, that underwent 90Y radioembolization at our institution between 2017 and 2024 were included in this single-center retrospective cohort. Sarcopenia was evaluated on CT imaging up to 60 days before the procedure by segmenting the psoas, erector spina, quadratus lumborum, transverse, internal, oblique, and rectus abdominis muscles and manually excluding intramuscular fatty plans. The generally accepted L3 skeletal muscle index (L3SMI) value {1, 2} was computed by dividing the sum of the areas of the muscles at the L3 level (cm2) by the patient's height (m2). L3SMI ≤ 40 cm2/m2 for men and ≤ 35 cm2/m2 for women was considered sarcopenia. Treatment response was evaluated at one month using mRECIST criteria and PET/MR imaging. Survival data were gathered from our clinic’s follow-up data and public records.

Results: 36 patients (40%) had sarcopenia. 40 patients (44%) had partial or complete response according to mRECIST criteria. 54 (60%) had stable disease or better response according to PET/MR imaging. These numbers were 12 (33%) and 14 (39%) in patients with sarcopenia. 62 (69%) patients were reported to be deceased during follow-up, and their mean survival was 17.4 months (range 1.5-84 months). Mean survival in patients with sarcopenia was 9.8 months (range 1.5-38 months). Sarcopenia was a predictor of mortality and worse treatment response independent of other factors.

Conclusion: Sarcopenia is associated with worse treatment response to 90Y radioembolization in BCLC stage B hepatocellular carcinoma. It was also identified as an independent predictor of survival, demonstrating a notable and statistically significant divergence in the survival curves of our patients. These findings highlight the significance of sarcopenia in prognosticating and stratifying risk for individuals with HCC undergoing 90Y radioembolization. Furthermore, they affirm the validity of employing CT-based sarcopenia evaluations within this patient cohort.