Prognostic impact of body composition in hepatocellular carcinoma patients with immunotherapy

This study aims to examine the possible relationship between body composition parameters, sarcopenia, and clinical outcomes in hepatocellular carcinoma (HCC) patients who received immune checkpoint inhibitor (ICI) treatment. Three online databases, including Embase, PubMed, and the Cochrane Library, were thoroughly searched for literature describing the relationship between body composition parameters, sarcopenia, and outcomes of ICI-treated HCC patients from the start of each database to 21 January 2024. The Newcastle-Ottawa Scale was used to rate the quality of the studies. The assessed outcomes included hazard ratio (HR) for OS and PFS, as well as odds ratio (OR) for ORR and DCR. This analysis included a total of 15 articles with a combined patient cohort of 1543 individuals. The results demonstrated that HCC patients with low skeletal muscle index (SMI) had significantly inferior OS (HR: 1.68, <i>p</i> &lt; 0.001), PFS (HR: 1.45, <i>p</i> &lt; 0.001), ORR (OR: 0.64, <i>p</i> = 0.044), and DCR (OR: 0.58, <i>p</i> = 0.009) compared to those with high SMI. The presence of sarcopenia in HCC patients was significantly related to poorer OS (HR: 1.63, <i>p</i> &lt; 0.001) and PFS (HR: 1.48, <i>p</i> &lt; 0.001), as well as a lower ORR (OR: 0.64, <i>p</i> = 0.020) and DCR (OR: 0.58, <i>p</i> = 0.007) in comparison to those without sarcopenia. Subgroup analysis demonstrated that these findings were consistent with the multivariate analysis. Moreover, high subcutaneous adipose index (SAI) levels were associated with better OS (HR: 0.46, <i>p</i> = 0.001) and PFS (HR: 0.68, <i>p</i> = 0.021) than those with low SAI levels. The presence of sarcopenia and low SMI in HCC patients undergoing treatment with ICIs was found to be related to inferior treatment response and reduced long-term effectiveness.

本研究旨在探讨接受免疫检查点抑制剂（immune checkpoint inhibitor, ICI）治疗的肝细胞癌（hepatocellular carcinoma, HCC）患者的身体成分参数、肌肉减少症与临床结局之间的潜在关联。我们系统检索了Embase、PubMed及Cochrane Library三个在线数据库，检索时限为各数据库建库至2024年1月21日，以获取描述身体成分参数、肌肉减少症与接受ICI治疗的HCC患者结局相关性的相关文献。采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对纳入研究的质量进行评分。本次分析的评估结局指标包括总生存期（overall survival, OS）的风险比（hazard ratio, HR）、无进展生存期（progression-free survival, PFS）的风险比（HR），以及客观缓解率（objective response rate, ORR）的比值比（odds ratio, OR）与疾病控制率（disease control rate, DCR）的比值比（OR）。本分析共纳入15篇文献，合并患者队列共计1543例。结果显示，与骨骼肌指数（skeletal muscle index, SMI）较高的HCC患者相比，骨骼肌指数较低的患者总生存期（HR=1.68，*p*<0.001）、无进展生存期（HR=1.45，*p*<0.001）、客观缓解率（OR=0.64，*p*=0.044）及疾病控制率（OR=0.58，*p*=0.009）均显著更差。与无肌肉减少症的HCC患者相比，合并肌肉减少症的患者总生存期（HR=1.63，*p*<0.001）、无进展生存期（HR=1.48，*p*<0.001）更差，且客观缓解率（OR=0.64，*p*=0.020）、疾病控制率（OR=0.58，*p*=0.007）更低，差异均具有统计学意义。亚组分析显示，上述结果与多因素分析结果一致。此外，皮下脂肪指数（subcutaneous adipose index, SAI）较高的患者相较于皮下脂肪指数较低的患者，总生存期（HR=0.46，*p*=0.001）与无进展生存期（HR=0.68，*p*=0.021）更优。本研究发现，接受ICI治疗的HCC患者若存在肌肉减少症及较低的骨骼肌指数，其治疗应答不佳且长期疗效降低。