Dynamic Muscle Atrophy Predicts Outcomes in Patients with Unresectable Hepatocellular Carcinoma Treated with First-Line Lenvatinib: A Retrospective Study in Taiwan.

BACKGROUND/AIMS: Muscle volume loss (MVL) is associated with poor outcomes in patients with hepatocellular carcinoma (HCC). However, dynamic muscle atrophy during HCC treatment is also a critical concern. This study aimed to determine the clinical significance of MVL and severe muscle atrophy following lenvatinib treatment among patients with unresectable HCC.

METHODS

This study included 302 patients with unresectable HCC who received first-line lenvatinib between July 2019 and December 2022. MVL was defined using the psoas muscle index, while severe muscle atrophy was classified as a ≥1.5% decrease in the psoas muscle index per month after lenvatinib initiation. To reduce the risk of selection bias, propensity score matching was performed.

RESULTS

After propensity score matching, 168 patients were included, comprising 112 non-MVL and 56 MVL patients. The MVL group had significantly worse overall survival (9.9 months vs 15.0 months, p=0.021) and a higher incidence of treatment-related adverse events (82.8% vs 66.6%, p=0.03) than the non-MVL group. Among 128 patients with dynamic imaging assessments, those with severe muscle atrophy (n=76) had significantly shorter progression-free survival (4.1 months vs 10.9 months, p<0.001) and overall survival (11.1 months vs 25.9 months, p<0.001) than patients with mild atrophy. Multivariate analysis revealed that severe muscle atrophy was an independent risk factor for progression-free survival (hazard ratio [HR], 2.388; 95% confidence interval [CI], 1.519 to 3.756; p<0.001) and overall survival (HR, 2.130; 95% CI, 1.152 to 3.939; p=0.016), while MVL was not.

CONCLUSIONS

In real-world clinical practice, severe muscle atrophy is a stronger prognostic indicator than MVL among patients with unresectable HCC treated with first-line lenvatinib.