INTRODUCTION
Despite being a rare tumor, hepatoblastoma is considered the most
frequent primary malignant tumor of the liver in the pediatric
population, accounting for up to 60% of these
neoplasms1. The establishment of prognostic factors
and the classification of patients into risk groups based on these has
allowed optimization of treatments. This has led to an increase in the
survival rate in recent years, reaching up to 75-90% of 5-year
event-free survival (EFS) according to the latest
studies2–4.
The chronic inflammation associated with the presence of oncological
disease, the reduction of physical activity, the intake decrease, as
well as the side effects associated with chemotherapy, lead these
patients to a state of malnutrition and generalized loss of muscle mass,
both in quality and strength. This syndrome is known as
sarcopenia5. The deleterious effect that the presence
of sarcopenia has on survival and the appearance of complications in
adult patients with oncological disease has been widely
studied6,7. In recent years some authors have
demonstrated the same prognostic role in pediatric patients with certain
hematological malignancies, and in
neuroblastomas8–10. Likewise, the recent study
performed by Ritz et al11 shows evidence of the
negative effect of perioperative sarcopenia status on the relapse rate
of patients with high-risk hepatoblastoma.
There are different techniques available to measure the degree of
sarcopenia, such as dual X-ray absorptiometry or bio-electrical
impedance analysis12,13. Similarly, the psoas muscle
area (PMA) measured on the axial plane on computed tomography (CT) or
magnetic resonance (MR) at L3-L4 or L4-L5 levels of the lumbar spine has
proven to be a validated and easy method for estimating the degree of
sarcopenia. Recent publications have established gender and age-specific
PMA reference values for pediatric patients.14.
The aim of our work is to study the prevalence of sarcopenia at
diagnosis in pediatric patients with hepatoblastoma, as well as its role
as a prognostic marker and predictor of post-surgical complications, EFS
and overall survival (OS).