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).