IDDF2018-ABS-0195 Reduced muscle (RADIO) density and barcelona clinic liver cancer (BCLC) staging are independently survival prognostic of indonesia hepatocellular carcinoma (HCC) patients

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Body composition components (Sarcopenia and intramuscular fat [IMF] deposition) were proven as risk factors predicting poor survival among HCC patients in the Japanese population. Since HCC characteristics were peculiar in Indonesia: advanced-stage at presentation; early-age onset; and HBV endemicity; our objective was to demonstrate key determinants of HCC prognosis in Indonesia.


Skeletal muscle index (SMI) and mean muscle attenuation (MA) were measured from transverse Computed Tomography (CT) images at the third lumbar vertebra (L3) in a prospective cohort of 49 Indonesia patients with different stages of HCC. Images were analysed using SliceOmatic V5.0 (Tomovision, QC Canada), which enables specific tissue demarcation using Hounsfield unit (HU) thresholds. Clinical, laboratory and body composition assessments are comprehensively analysed using Kaplan-Meier procedure and Cox’s regression model to investigate critical features associated with prognosis.


Patients with low MA (called intramuscular fat [IMF] deposition) had shorter median survival than non-IMF deposition (73 11.61 vs. 252 26.56 days, p=0.008) as also observed shorter in patients with alpha-fetoprotein (AFP) level ≥200 ng/ml than AFP <200 ng/ml (69 31.31 vs. 92 86.03 days, p=0.015) as depicted in IDDF2018-ABS-0195 Figure 1. By univariate analysis, IMF deposition (p=0.012), HBV (p=0.048), Child-Pugh (CP) class B (p=0.019), CP class C (p<0.001), BCLC stage C (p=0.009), BCLC stage D (p<0.001) and AFP ≥200 ng/ml (p=0.018) were significantly associated with mortality. However, multivariate analysis revealed that only IMF deposition (HR, 2.390; 95% CI, 1.007–5.673; p=0.048), BCLC stage C (HR, 4.641; 95% CI, 1.369–15.732; p=0.014) and BCLC stage D (HR, 14.681; 95% CI, 3.158–68.253; p=0.001) were independently associated with mortality.


Muscle Attenuation and BCLC stage were significant independent predictors of survival in HCC Indonesian patients. External validation of these prognostic factors in larger cohorts of HCC patients is warranted.

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