RESULTS
Patients and groups characteristics
Fifty-two patients were diagnosed with hepatoblastoma in our center
during the study period, of which 21 patients were finally included. The
remaining 31 patients were excluded due to the reasons specified in
Figure 2. Twelve patients (57.1%) were male and the median age at
diagnosis was 35.7 months (IQR 23.3;58.5 months). Two patients were
classified as PRETEXT I (9.5%), 6 (28.6%) as PRETEXT II, 8 (38.1%) as
PRETEXT III and 5 (23.8%) as PRETEXT IV. 3 patients (14.3%) showed
lung metastases at diagnosis. Twelve patients (57.1%) were surgically
treated by liver resection and 9 (42.9%) underwent liver
transplantation. The remaining demographic characteristics are
summarized in Table 1.
Sarcopenia status
To determine sarcopenia status, tPMA z-score values was obtained from
baseline cross-sectional imaging available. CT was available for 12
patients (57.1%) and MR for 9 (42.9%). Seven out of the 21 patients
(33.3%) met sarcopenia criteria and were included in the SP group. The
remaining 14 patients (66.7%) where included in the NSP group.
There were no statistically significant differences in age, weight, BMI,
or α-fetoprotein levels at diagnosis between the two groups (Table 1).
When studying the relationship between tPMA z-score values and
anthropometric and analytical parameters, there was a moderate
correlation with weight at diagnosis (r=0.60; p=0.015). No correlation
was observed with BMI values (r=-0.29; p=0.92), serum albumin levels
(r=0.30; p=0.96) or serum total proteins levels (r=0.23; p=0.92) as
shown in Figure 3.
Sarcopenia was associated with a more advanced-stage disease, with
42.9% (n=3) of patients in the SP group showing metastases at
diagnosis, compared to none (0.0%) in the NSP group (p=0.026). However,
there were no differences in terms of hepatoblastoma risk group (p=0.54)
or PRETEX status (p=0.16) between the two groups (Table 1). Likewise,
there was no correlation between tPMA and tumor volume (r=0.44; p=0.12).
Sarcopenia and post-surgical outcomes
Regarding the surgical approach, as shown in Table 1, no significant
differences were observed between the two groups (p=0.68). Liver
resection or liver transplantation were the surgical treatment in 57.1%
and 42.9% of patients respectively in both groups.
A statistically significant increase in the postoperative complications
was observed in the SP group, reaching 57.1% (n=4), compared to 21.4%
(n=3) in the NSP group [OR=13.33; 95%CI (1.05-169.56); p=0.047].
According to Clavien-Dindo classification, these complications were
classified as grade III: biliary leak (n=3; 14.3%) and intra-abdominal
abscess (n=1; 4.8%), as well as grade IV: bleeding (n=3; 14.3%) and
portal thrombosis (n=1; 4.8%). Postoperative complications classified
as grade I and II did not have been take into account.
Sarcopenia status was not associated with a significant increase in the
median length of post-operative ICU stay, this being 6.5 (1.2-14.0) days
for the SP group and 5 (2.5-5.0) days for the NSP group (p=0.96).
Moreover, no significant differences were observed between groups in the
median length of overall hospital stay, being 11 (7.0-13.0) vs. 13.5
(10.3-21.5) days, respectively (p=0.44).
Sarcopenia status and survival outcomes
Median follow-up of the patients included in this study was 65.07
(1.67-144.77) months. During this period, 2 patients (28.6%) from the
SP group had a tumor relapse versus 1 patient (7.1%) in the NSP group
(p=0.25). Mean EFS for the SP group was 100.38 ± 25.63 months vs. 118.91
± 11.52 months in the NSP group (p=0.25). Five-year EFS for SP group was
69% vs. 88% for NSP group (Figure 4).
Two patients (28.6%) died during the study period in the SP group,
compared to 1 patient (7.1%) in the NSP group (p=0.25). The mean OS was
101.72 ± 24.86 months for the SP group, versus 121.78 ± 8.75 months in
the NSP group (p=0.28). Albeit not statistically significant, a higher
value of 5-year OS was evidenced in the NSP group, which reached 87%,
compared to 71% observed in the SP group (Figure 5).
Due to the low number of patients and events observed, multivariate
analysis could not be performed.