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.