Impact of Sarcopenia and Serum Creatinine on Clinical Outcomes after Tace in Hepatocellular Carcinoma.

BACKGROUND

Transarterial chemoembolization (TACE) is the standard treatment for intermediate unresectable hepatocellular carcinoma (HCC); however, reliable prognostic markers are still lacking. Sarcopenia has been proposed as a negative prognostic factor in HCC, but its impact on TACE outcomes remains unclear.

METHODS

We retrospectively analyzed 48 HCC patients treated with TACE or transarterial embolization (TAE) at our institution (between 2013 and 2020). Sarcopenia was assessed on computed tomography (CT) or magnetic resonance imaging (MRI) scans at baseline, one month, and six months after treatment according to RECIST criteria.

RESULTS

At six months, 27 patients (61.4%) achieved complete or partial response, while 17 (38.6%) experienced stable or progressive disease; four patients were excluded due to missing follow-up data. Sarcopenia was more frequent among responders, increasing from 13.5% at baseline to 22.2% in 6 months, while it was initially absent in non-responders. Conversely, non-responders showed a later increase in sarcopenia (0% at baseline to 29.6% at 6 months), suggesting that late sarcopenia might reflect treatment-related metabolic changes. Overall, the prevalence of sarcopenia increased during follow-up. New-onset sarcopenia was more frequent in non-responders and was associated with lower serum creatinine levels , suggesting a possible link between treatment-related muscle loss and poor therapeutic response. Kaplan-Meier showed that smoking status was associated (p = 0.01) with poorer response at 6 months (), while sarcopenia and low creatinine levels showed borderline associations (p = 0.095).

CONCLUSION

In this exploratory study, baseline CT-defined sarcopenia was not significantly associated with short-term response to TACE. However, treatment-related sarcopenia with low creatinine levels may reflect frailty during follow-up, and poorer therapeutic response. Given the small sample size and limited number of sarcopenic patients, these findings should be considered hypothesis-generating and require validation in larger prospective studies.