Comment on ‘Myosteatosis and Muscle Loss Impact Liver Transplant Outcomes in Male Patients With Hepatocellular Carcinoma’ by Lu et al.

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2024-10-20 DOI:10.1002/jcsm.13620
Aikaterini Kamiliou, Vasileios Lekakis, George Xynos, Evangelos Cholongitas
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Abstract

We read with great interest the article by Lu et al. [1] regarding the impact of myosteatosis on post–liver transplantation (LT) outcome in males transplanted for hepatocellular carcinoma (HCC). The authors reported a relatively low prevalence of myosteatosis (27.8% in males) using a gender-based definition (i.e., muscle attenuation less than 37.5 HU at the third lumbar vertebra of cross-sectional CT image for men). However, in our recently published meta-analysis [2] including 10 studies with 3316 HCC patients, the overall pooled prevalence of myosteatosis was estimated as high as 50% (95% confidence interval [CI] 35%–65%) [2]. This discrepancy could be attributed to the fact that Lu et al. [1] included mainly chronic hepatitis B–associated HCC patients, although all patients were Asians. Indeed, our meta-analysis showed that the prevalence of myosteatosis is significantly lower in Asian HCC patients, compared to the non-Asian HCC patients (pooled prevalence 45% vs. 69%, respectively, p = 0.02), whereas viral-associated HCC patients have significantly less frequently myosteatosis, compared to those with fatty or alcoholic liver disease–associated HCC (pooled prevalence 49% vs. 65% vs. 86%, respectively, p < 0.001). Interestingly, the authors [1] concluded that myosteatosis was not associated with post-LT outcome in females, although they did not provide which cutoff was used for definition of myosteatosis in this subgroup, although no clear explanation was given for this finding. In addition, they found no association between myosteatosis and hepatic encephalopathy although our meta-analysis [3] showed that cirrhotic patients with myosteatosis, compared to those without myosteatosis, have more frequently a previous history of hepatic encephalopathy (32% vs. 15%, p = 0.04) possibly related with the reduction of skeletal muscle capacity to remove ammonia. Finally, it would be interesting if the authors evaluated the impact of diabetes mellitus, which is an known factor associated with myosteatosis and poor prognosis after LT [3, 4], as well as if they compared the post-LT outcome of HCC patients with sarcopenia and myosteatosis/isolated myosteatosis versus those with isolated sarcopenia, as recent studies have shown that myosteatosis may be a more important factor, compared to sarcopenia, in the pre-LT setting of patients without HCC [5].

Nevertheless, Lu et al. [1] confirmed the predictive role of myosteatosis in HCC patients not only in the pre-LT setting [2] but also in the post-LT outcome [1], indicating the importance of including assessment of myosteatosis in the process for LT evaluation. However, their results [1] need validation in non-Asian populations, in which the aetiology of liver disease is more frequently metabolic and alcohol-related HCC.

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就 Lu 等人撰写的 "肌肉骨质疏松症和肌肉缺失影响男性肝细胞癌患者的肝移植预后 "发表评论
我们饶有兴趣地阅读了 Lu 等人[1]撰写的文章,该文探讨了肝细胞癌(HCC)男性移植患者肌骨营养不良对肝移植(LT)后疗效的影响。作者采用基于性别的定义(即男性横断面 CT 图像中第三腰椎处的肌肉衰减小于 37.5 HU)报告了相对较低的肌骨肥厚症发病率(男性为 27.8%)。然而,在我们最近发表的荟萃分析[2](包括 10 项研究,共 3316 例 HCC 患者)中,肌肉骨质疏松症的总患病率估计高达 50%(95% 置信区间[CI] 35%-65%)[2]。这一差异可能是由于 Lu 等人[1] 主要纳入了慢性乙型肝炎相关的 HCC 患者,尽管所有患者都是亚洲人。事实上,我们的荟萃分析表明,与非亚洲 HCC 患者相比,亚洲 HCC 患者的肌骨软化症发病率明显较低(汇总发病率分别为 45% 与 69%,P = 0.02),而与脂肪肝或酒精性肝病相关的 HCC 患者相比,病毒相关的 HCC 患者的肌骨软化症发病率明显较低(汇总发病率分别为 49% 与 65% 与 86%,P <0.001)。有趣的是,作者[1]得出结论认为,女性骨质疏松症与LT后的结果无关,但他们没有提供在该亚组中定义骨质疏松症时使用的临界值,也没有对这一发现给出明确的解释。此外,尽管我们的荟萃分析[3]显示,与没有肌骨骼疏松症的肝硬化患者相比,患有肌骨骼疏松症的肝硬化患者更常出现肝性脑病(32% 对 15%,P = 0.04),但他们并未发现肌骨骼疏松症与肝性脑病之间存在关联,这可能与骨骼肌清除氨的能力下降有关。最后,如果作者能评估一下糖尿病的影响(众所周知,糖尿病与肌骨软化症和 LT 后不良预后有关[3, 4]),并比较一下患有肌少症和肌骨软化症/孤立性肌骨软化症的 HCC 患者与孤立性肌骨软化症患者的 LT 后预后,那将会非常有趣,因为最近的研究表明,在无 HCC 患者的 LT 前设置中,肌骨软化症可能是比肌少症更重要的因素[5]。不过,Lu 等人[1] 证实,肌骨疏松不仅对 HCC 患者的长管治疗前[2]有预测作用,而且对长管治疗后的结果也有预测作用[1],这表明将肌骨疏松评估纳入长管治疗评估过程的重要性。然而,他们的研究结果[1]需要在非亚洲人群中进行验证,因为在非亚洲人群中,肝病的病因更多是代谢和酒精相关性 HCC。
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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
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期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
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