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Abstract：
OBJECTIVE: The aim of this pilot study is to explore the relationship between changes in sarcopenia before and after one to three months of Transarterial Radioembolization (TARE) treatment with Holmium-166 (166Ho) and its effect on the rate of local response. Our primary objective is to assess whether the worsening of sarcopenia can function as an early indicator of a subgroup of patients at increased risk of disease progression in cases of hepatocellular carcinoma (HCC).
METHODS: A single-center retrospective analysis was performed on 25 patients with HCC who underwent 166Ho-TARE. Sarcopenia status was defined according to the measurement of the psoas muscle index (PMI) at baseline, one month, and three months after TARE. Radiological response according to mRECIST criteria was assessed and patients were grouped into responders and non-responders. The loco-regional response rate was evaluated for all patients before and after treatment, and was compared with sarcopenia status to identify any potential correlation.
RESULTS: A total of 20 patients were analyzed. According to the sarcopenia status at 1 month and 3 months, two groups were defined as follows: patients in which the deltaPMI was stable or increased (No-Sarcopenia group; n = 12) vs. patients in which the deltaPMI decreased (Sarcopenia group; n = 8). Three months after TARE, a significant difference in sarcopenia status was noted (p = 0.041) between the responders and non-responders, with the non-responder group showing a decrease in the sarcopenia values with a median deltaPMI of -0.57, compared to a median deltaPMI of 0.12 in the responder group. Therefore, deltaPMI measured three months post-TARE can be considered as a predictive biomarker for the local response rate (p = 0.028). Lastly, a minor deltaPMI variation (>-0.293) was found to be indicative of positive treatment outcomes (p = 0.0001).
CONCLUSIONS: The decline in sarcopenia three months post-TARE with Holmium-166 is a reliable predictor of worse loco-regional response rate, as evaluated radiologically, in patients with HCC. Sarcopenia measurement has the potential to be a valuable assessment tool in the management of HCC patients undergoing TARE. However, further prospective and randomized studies involving larger cohorts are necessary to confirm and validate these findings.
METHODS: A single-center retrospective analysis was performed on 25 patients with HCC who underwent 166Ho-TARE. Sarcopenia status was defined according to the measurement of the psoas muscle index (PMI) at baseline, one month, and three months after TARE. Radiological response according to mRECIST criteria was assessed and patients were grouped into responders and non-responders. The loco-regional response rate was evaluated for all patients before and after treatment, and was compared with sarcopenia status to identify any potential correlation.
RESULTS: A total of 20 patients were analyzed. According to the sarcopenia status at 1 month and 3 months, two groups were defined as follows: patients in which the deltaPMI was stable or increased (No-Sarcopenia group; n = 12) vs. patients in which the deltaPMI decreased (Sarcopenia group; n = 8). Three months after TARE, a significant difference in sarcopenia status was noted (p = 0.041) between the responders and non-responders, with the non-responder group showing a decrease in the sarcopenia values with a median deltaPMI of -0.57, compared to a median deltaPMI of 0.12 in the responder group. Therefore, deltaPMI measured three months post-TARE can be considered as a predictive biomarker for the local response rate (p = 0.028). Lastly, a minor deltaPMI variation (>-0.293) was found to be indicative of positive treatment outcomes (p = 0.0001).
CONCLUSIONS: The decline in sarcopenia three months post-TARE with Holmium-166 is a reliable predictor of worse loco-regional response rate, as evaluated radiologically, in patients with HCC. Sarcopenia measurement has the potential to be a valuable assessment tool in the management of HCC patients undergoing TARE. However, further prospective and randomized studies involving larger cohorts are necessary to confirm and validate these findings.
摘要：
目的：这项初步研究的目的是探讨经动脉放射性栓塞（TARE）治疗Holmium-166（166Ho）1至3个月前后肌肉减少症的变化及其对局部反应率的影响之间的关系。我们的主要目标是评估肌少症的恶化是否可以作为肝细胞癌（HCC）病例中疾病进展风险增加的患者亚组的早期指标。
方法：对25例接受166Ho-TARE治疗的HCC患者进行单中心回顾性分析。根据基线时的腰大肌指数（PMI）的测量来定义肌肉减少症状态，一个月,和三个月后的TARE。根据mRECIST标准评估放射学反应，并将患者分为反应者和非反应者。对所有患者治疗前后的局部区域反应率进行评估，并与肌肉减少症状态进行比较，以确定任何潜在的相关性。
结果：共分析20例患者。根据1个月和3个月的肌少症状况，两组的定义如下：deltaPMI稳定或升高的患者（无肌肉减少症组；n=12）与deltaPMI降低的患者（肌肉减少症组；n=8）。TARE三个月后,有反应者和无反应者之间的肌少症状态存在显着差异（p=0.041），无应答者组的肌肉减少症值降低,deltaPMI中位数为-0.57,而应答者组的deltaPMI中位数为0.12.因此,TARE后三个月测量的deltaPMI可以被认为是局部反应率的预测性生物标志物(p=0.028)。最后,发现微小的deltaPMI变异(>-0.293)表明治疗结果为阳性(p=0.0001).
结论：TARE+166治疗后3个月肌肉减少症是局部区域反应率较差的可靠预测指标，根据放射学评估，在HCC患者中。肌肉减少症测量有可能成为接受TARE的HCC患者管理中的有价值的评估工具。然而,需要更多涉及更大队列的前瞻性和随机研究来确认和验证这些发现.
方法：对25例接受166Ho-TARE治疗的HCC患者进行单中心回顾性分析。根据基线时的腰大肌指数（PMI）的测量来定义肌肉减少症状态，一个月,和三个月后的TARE。根据mRECIST标准评估放射学反应，并将患者分为反应者和非反应者。对所有患者治疗前后的局部区域反应率进行评估，并与肌肉减少症状态进行比较，以确定任何潜在的相关性。
结果：共分析20例患者。根据1个月和3个月的肌少症状况，两组的定义如下：deltaPMI稳定或升高的患者（无肌肉减少症组；n=12）与deltaPMI降低的患者（肌肉减少症组；n=8）。TARE三个月后,有反应者和无反应者之间的肌少症状态存在显着差异（p=0.041），无应答者组的肌肉减少症值降低,deltaPMI中位数为-0.57,而应答者组的deltaPMI中位数为0.12.因此,TARE后三个月测量的deltaPMI可以被认为是局部反应率的预测性生物标志物(p=0.028)。最后,发现微小的deltaPMI变异(>-0.293)表明治疗结果为阳性(p=0.0001).
结论：TARE+166治疗后3个月肌肉减少症是局部区域反应率较差的可靠预测指标，根据放射学评估，在HCC患者中。肌肉减少症测量有可能成为接受TARE的HCC患者管理中的有价值的评估工具。然而,需要更多涉及更大队列的前瞻性和随机研究来确认和验证这些发现.
