Wen Chen,1,* Hai-Tao Yan,1,* Jin-Xing Zhang,1 Xiao Shen,1 Jin Liu,2 Sheng Liu,1 Hai-Bin Shi,1 Ye Ding,3 Qing-Quan Zu1 

1Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, People’s Republic of China; 2Department of Clinical Medicine Research Institution, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, People’s Republic of China; 3Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ye Ding, Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, People’s Republic of China, Tel +86-025-8686-8459, Email dingye@njmu.edu.cn Qing-Quan Zu, Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210029, People’s Republic of China, Tel +86-13913807470, Email zuqingquan@njmu.edu.cn

Purpose: To assess the relationship between clinical prognosis and changes of skeletal muscle mass for unresectable hepatocellular carcinoma (uHCC) patients who received transarterial chemoembolization (TACE) with molecular-targeted agents and immune checkpoint inhibitors (TACE-MTAs-ICIs).
Methods: From June 2019 to June 2023, a total of 92 uHCC patients who received TACE-MTAs-ICIs therapy were included. Skeletal muscle mass was assessed before and 6 months after treatment. Skeletal muscle index (SMI) is calculated as skeletal muscle area at the L3 vertebra divided by the square of height, then the change rate of SMI (ΔSMI) is calculated. Patients were stratified based on ΔSMI as muscle gain and non-muscle gain groups. Overall survival (OS) was compared between groups and prognostic factors for OS were analyzed. Progression-free survival (PFS) was also recorded.
Results: The median OS in the muscle gain group was significantly longer than that in the non-muscle gain group (Not reach vs 25.2 months, P < 0.001). The median PFS did not reach significant between two groups (16.2 vs 9.1 months, P = 0.101). Multivariate analyses revealed that skeletal muscle gain (HR = 0.20; 95% CI, 0.06– 0.68; P = 0.010) and Barcelona Clinic Liver Cancer stage (HR = 1.94; 95% CI, 1.02– 3.69; P = 0.044) were independent prognostic factors for OS.
Conclusion: SMI increment appeared as a favorable predictor for these uHCC patients who received TACE-MTAs-ICIs therapy.

Keywords: hepatocellular carcinoma, immune checkpoint inhibitors, molecular targeted therapy, sarcopenia, transarterial chemoembolization