Effect of sarcopenia on systemic targeted therapy response in patients with advanced hepatocellular carcinoma

Aliya Qayyum, Priya Bhosale, Rizwan Aslam, Rony Avritscher, Jingfei Ma, Mark D. Pagel, Jia Sun, Yehia Mohamed, Asif Rashid, Laura Beretta, Ahmed O. Kaseb

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Purpose: Sarcopenia is an independent prognostic indicator for hepatocellular carcinoma (HCC). Our objective was to determine the effect of sarcopenia on response to systemic targeted therapy in patients with advanced HCC. Materials and methods: This was a retrospective, Institutional Review Board approved study of 36 patients on systemic targeted therapy with immune checkpoint blockade (n = 25) or tyrosine kinase inhibitor (n = 11) for biopsy-proven advanced HCC. Skeletal muscle index (SMI) was calculated from erector spinae muscle area (SMA) at the level of T12 on pretreatment CT: [SMI = SMA (cm2)/height (m2)]. SMI was compared to treatment response defined as overall survival ≥ 1 year (nonsurgical patients) or > 50% HCC necrosis (surgical patients). Receiver operating characteristic curve and area under the curve was used for analysis with p < 0.05 for statistical significance. Results: Median age of men and women was 66.5 years (range 32–83) and 70 years (range 54–78), respectively. Liver disease etiology was nonalcoholic steatohepatitis (n = 9), hepatitis C (n = 10), hepatitis B (n = 5), alcohol (n = 3) and unknown (n = 9). Mean (± SD) height and SMI for men were 1.7 m (± 0.1) and 11.4 (± 3.6); values for women were 1.7 m (± 0.1) and 8.2 (± 1.9). Treatment was withdrawn in five patients due to treatment intolerance. Response occurred in 10/31 (32.3%) patients (23 men, 8 women). T12SMI correlated with treatment response using a threshold of 7.21-8.23 for women (AUC = 1; p = 0.037), and 11.47 for men (AUC = 0.83; p = 0.015); correlation was increased for men ≥ 60 years, (AUC = 0.87; p = 0.023). Conclusion: Sarcopenia was associated with reduced survival and HCC necrosis in patients treated with systemic targeted therapy. Clinical relevance: Sarcopenia may help in predicting outcomes to targeted therapy in advanced HCC.

Original languageEnglish (US)
Pages (from-to)1008-1015
Number of pages8
JournalAbdominal Radiology
Issue number3
StatePublished - Mar 2021


  • HCC
  • Immunotherapy
  • Sarcopenia

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology


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