scholarly journals Sarcopenic Factors May Have No Impact on Outcomes in Ovarian Cancer Patients

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 206 ◽  
Author(s):  
Naomi Nakayama ◽  
Kentaro Nakayama ◽  
Kohei Nakamura ◽  
Sultana Razia ◽  
Satoru Kyo
Keyword(s):  
Ovarian Cancer ◽  
Skeletal Muscle ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Muscle Volume ◽  
Muscle Quality ◽  
Prognostic Impact ◽  
Poor Prognostic Factor ◽  
Skeletal Muscle Index ◽  
The Impact

Although the prognostic value of sarcopenic factors, such as loss of muscle mass and quality, have been widely reported in patients with cancer during the last decade, the value in those with ovarian cancer remains unclear. Therefore, this study evaluated the prognostic impact of sarcopenic factors in patients with ovarian cancer. We retrospectively evaluated the data of 94 ovarian cancer patients who underwent surgery and chemotherapy at the Shimane University Hospital between March 2006 and 2013. Preoperative computed tomography scan at the level of the third lumbar vertebra was used to evaluate skeletal muscle volume and quality based on the skeletal muscle index (SMI) and intramuscular adipose tissue content (IMAC), respectively. The impact of preoperative SMI and IMAC on outcomes was subsequently investigated. Low SMI and high IMAC were not significantly associated with disease-free survival (p = 0.329 and p = 0.3370, respectively) or poor overall survival (p = 0.921 and p = 0.988, respectively). Neither preoperative low muscle volume nor low muscle quality was a poor prognostic factor in ovarian cancer.

scholarly journals Prognostic role of computed tomography-based, artificial intelligence-driven waist skeletal muscle volume in uterine endometrial carcinoma

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Se Ik Kim ◽  
Joo Yeon Chung ◽  
Haerin Paik ◽  
Aeran Seol ◽  
Soon Ho Yoon ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Computed Tomography ◽  
Skeletal Muscle ◽  
Endometrial Cancer ◽  
Survival Rate ◽  
Muscle Volume ◽  
Survival Outcomes ◽  
Poor Prognostic Factor ◽  
Skeletal Muscle Index ◽  
The Impact

Abstract Objectives To investigate the impact of computed tomography (CT)-based, artificial intelligence-driven waist skeletal muscle volume on survival outcomes in patients with endometrial cancer. Methods We retrospectively identified endometrial cancer patients who received primary surgical treatment between 2014 and 2018 and whose pre-treatment CT scans were available (n = 385). Using an artificial intelligence-based tool, the skeletal muscle area (cm2) at the third lumbar vertebra (L3) and the skeletal muscle volume (cm3) at the waist level were measured. These values were converted to the L3 skeletal muscle index (SMI) and volumetric SMI by normalisation with body height. The relationships between L3, volumetric SMIs, and survival outcomes were evaluated. Results Setting 39.0 cm2/m2 of L3 SMI as cut-off value for sarcopenia, sarcopenia (< 39.0 cm2/m2, n = 177) and non-sarcopenia (≥ 39.0 cm2/m2, n = 208) groups showed similar progression-free survival (PFS; p = 0.335) and overall survival (OS; p = 0.241). Using the median value, the low-volumetric SMI group (< 206.0 cm3/m3, n = 192) showed significantly worse PFS (3-year survival rate, 77.3% vs. 88.8%; p = 0.004) and OS (3-year survival rate, 92.8% vs. 99.4%; p = 0.003) than the high-volumetric SMI group (≥ 206.0 cm3/m3, n = 193). In multivariate analyses adjusted for baseline body mass index and other factors, low-volumetric SMI was identified as an independent poor prognostic factor for PFS (adjusted HR, 1.762; 95% CI, 1.051–2.953; p = 0.032) and OS (adjusted HR, 5.964; 95% CI, 1.296–27.448; p = 0.022). Conclusions Waist skeletal muscle volume might be a novel prognostic biomarker in patients with endometrial cancer. Assessing body composition before treatment can provide important prognostic information for such patients.

Pretreatment skeletal muscle depletion as an adverse prognostic factor in metastatic gastric cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 161-161
Author(s):  
Hiroko Hasegawa ◽  
Kazumasa Fujitani ◽  
Yusuke Yamaoka ◽  
Motohiro Hirao ◽  
Shoichi Nakazuru ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Skeletal Muscle ◽  
Prognostic Factor ◽  
Cancer Patients ◽  
Performance Status ◽  
Metastatic Gastric Cancer ◽  
First Line ◽  
Skeletal Muscle Index ◽  
Pre Treatment ◽  
The Impact

161 Background: Body composition has emerged as an important prognostic factor in cancer patients. Especially, skeletal mass depletion has been associated with poor performance status, toxicity of chemotherapy and shortened survival in cancer patients. However, the impact of pre-treatment skeletal muscle index on survival or toxicity in metastatic gastric cancer patients remains uncertain. Methods: In this retrospective study, we reviewed 98 metastatic gastric cancer (mGC) patients who received S-1 based combination chemotherapy as first-line treatment from April 2006 to March 2013. Pre-treatment skeletal muscle mass was quantified by CT cross sectional area at the third lumbar vertebrae and evaluated as lumbar skeletal muscle index (SMI) (cm2/m2) after normalization for stature (m2). Patients were categorized into 2 groups depending on initial SMI: 35 patients with SMI ≤ 40 and 63 patients with SMI > 40. Results: Median overall survival was significantly shorter in the SMI ≤ 40 group than in the SMI >40 group (439 days versus 565 days; p= 0.03). Progression free survival was also better in the SMI> 40 group without statistical significance (175 days versus 151 days; p= 0.17). Toxicity (grade 3 or 4) was more common in the SMI ≤ 40 group than in the SMI >40 group. (41.1% versus 11.1%; p=0.001). In multivariate analysis, performance status of 2 (HR 4.711, 95%CI 1.065 to 20.832, p=0.04), presence of primary tumor (HR 2.322, 95%CI 1.007 to 5.357, p=0.04) and pre-treatment SMI (HR 2.525, 95%CI 1.145 to 5.568, p=0.02) were independent prognostic factors for OS. Conclusions: The present study suggests that skeletal muscle depletion at the initiation of first-line chemotherapy might be an independent prognostic factor for mGC patients.

Myopenia as a significant prognostic factor in BCLC-B intermediate-stage hepatocellular carcinoma treated with sorafenib.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15639-e15639
Author(s):  
Mao Okada ◽  
Hiroyuki Nakanishi ◽  
Masayuki Kurosaki ◽  
Sakura Kirino ◽  
Leona Osawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Skeletal Muscle ◽  
Prognostic Factor ◽  
Kinase Inhibitors ◽  
Treatment Options ◽  
Intermediate Stage ◽  
Significant Prognostic Factor ◽  
Poor Prognostic Factor ◽  
Skeletal Muscle Index ◽  
The Impact

e15639 Background: Tyrosine kinase inhibitors (TKI) are important treatment options for unresectable hepatocellular carcinoma (HCC). The survival benefit of sorafernib was demonstrated not only in advanced stage but also for BCLC-B intermediate stage who are refractory to transcatheter arterial chemoembolization by OPTIMIS study. Skeletal muscle mass depletion (Myopenia) is a poor prognostic factor in HCC treated by resection or loco-reginal ablation, but its effect on survival in TKI treated patients, especially in those within BCLC-B stage remains unclear. The aim of the present study is to elucidate the impact of myopenia on survival among HCC treated with sorafenib, especially in BCLC-B stage. Methods: In 213 patients who started treatment with sorafenib between 2009 and 2016, myopenia at baseline was determined by using skeletal muscle index calculated from CT images of the third lumber vertebra level. The impact of myopenia on survival was analyzed in whole patients, after stratification by BCLC stage, and after matching for backgrounds within BCLC-B patients. Results: The median survival in whole, BCLC-C, and –B was 13.7, 8.7 and 15.2 months, respectively. Myopenia was not a significant prognostic factor in whole patients and in BCLC-C stage. However, among BCLC-B patients (n = 104), survival was significantly better in patients with no myopenia (p = 0.05). Among them, 85 patients who continued sorafenib for more than 8 weeks were extracted and those with or without myopenia were matched for backgrounds by propensity score. Backgrounds including etiology, Child-Pugh score, BMI, AFP and PIVKA-Ⅱwas not different between myopenia (n = 30) and no myopenia group (n = 30) after matching. The overall survival at 6-, 12-, and 24-months was 96%, 74%, and 62% in no myopenia group which was significantly better compared to 89%, 64%, and 28% in myopenia group (p = 0.019). The hazard ratio was 2.12 (95% CI 1.11-4.03). Conclusions: Absence of myopenia predicts favorable outcome in sorafenib treated HCC patients within BCLC-B intermediate stage.

Significance of changes in serum CA125 level on overall survival in ovarian cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16546-e16546
Author(s):  
S. Williams ◽  
D. Gupta ◽  
S. Dahlk ◽  
K. E. Dzike ◽  
G. M. Lambert ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Case Series ◽  
Stage Iv ◽  
Time Interval ◽  
Prognostic Impact ◽  
Baseline Serum ◽  
Serum Ca125 ◽  
The Impact

e16546 Background: The role of baseline serum CA125 as a prognostic indicator in ovarian cancer is well documented. However, little is known about the impact of change in CA125 on survival after 3 months of therapy. We conducted survival analysis to answer the question “what is the prognostic impact of change in serum CA125 after 3 months of therapy in ovarian cancer?” Methods: A case series of 170 ovarian cancer patients treated at Cancer Treatment Centers of America between Jan 01 and May 06. Based on CA125 levels at baseline and 3 months, patients were classified into 4 groups: 1) Normal (0–35U/ml) at baseline and three months; 2) High (>35U/ml) at baseline, normal at three months; 3) Normal at baseline, high at 3 months; 4) High at baseline and three months. Kaplan Meier method was used to calculate survival across the 4 categories, which was defined as the time interval between date of patient visit at 3 months from first visit and date of death from any cause or date of last contact. Results: Of 170 patients, 36 were newly diagnosed while 134 had received prior treatment. 25 had stage I disease at diagnosis, 15 stage II, 106 stage III and 14 stage IV. The median age at presentation was 54.2 years (range 23.1 - 82.5 years). At baseline, 31 patients had normal (0–35U/ml) serum CA125 levels while 138 had high (>35U/ml) levels. At 3 months, 59 had normal while 111 had high levels. In this cohort, patients with a reduced CA125 at 3 months (stratum 2) had a significantly better survival than those with increased CA125 at 3 months (stratum 3). Patients with normal values of CA125 at both baseline and 3 months (stratum 1) had the best overall survival. Conclusions: These data show that reduction in CA125 after 3 months of therapy is associated with better overall survival in ovarian cancer. Patients without a significant decline in CA125 after 3 months of therapy have a particularly poor prognosis. [Table: see text] No significant financial relationships to disclose.

Change of skeletal muscle index during the chemotherapy as a prognostic factor of survival in pancreatic cancer patients receiving palliative chemotherapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 363-363
Author(s):  
Younak Choi ◽  
Tae Yong Kim ◽  
Kyung-Hun Lee ◽  
Sae-Won Han ◽  
Do-Youn Oh ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Prognostic Factor ◽  
Cancer Patients ◽  
Palliative Chemotherapy ◽  
Cross Sectional ◽  
Poor Prognostic Factor ◽  
Skeletal Muscle Index ◽  
Korean People ◽  
Muscle Cross Sectional Area

363 Background: Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at the diagnosis and progressive loss of skeletal muscle were associated with survival in pancreatic cancer (PC) patients receiving palliative chemotherapy. Methods: We retrospectively reviewed PC patients receiving palliative chemotherapy between 2003 and 2010. Skeletal muscle cross-sectional area at L3 was measured by computed tomography. Sarcopenia was defined using the previously published sex-specific cutoff points for Korean people. Loss of skeletal muscle was classified by sex-specific cutoffs from ROC curve. Results: Among 484 patients, 260 (53.7%) patients were more than sixty years old and 295 (61.0%) patients were male. Overall, 187 (38.6%) patients were sarcopenic at the diagnosis (male, <49.2cm2/m2; female, <31.1 cm2/m2). Decreased skeletal muscle index (SMI) during the chemotherapy, which was defined as a reduction by more than 0.21 for male and by more than 2.19 for female, was observed in 198 (77.3%) male patients and 61 (38.1%) female patients. Decreased body mass index (BMI) by more than 1 was observed in 149 patients (37.3%) without difference between genders. Median overall survival (OS) of whole patients was 8.4 months [95%CI 7.6-9.2]. In the multivariate analysis, sarcopenia (p=0.001), decreased SMI (p=0.003), and decreased BMI (p=0.001) was significantly poor prognostic factors for OS. When we analyzed four groups by SMI and BMI changes (maintained SMI and BMI, maintained SMI and decreased BMI, decreased SMI and maintained BMI, decreased SMI and BMI), the groups with maintained SMI had longer survival than the groups with decreased SMI regardless of BMI changes. Median OS was 11.5 months with maintained SMI and 8.1 months with decreased SMI (HR 0.534 and 1, p=0.004) in decreased BMI groups and 9.9 months with maintained SMI and 8.6 months with decreased SMI (HR 1 and 1.490, p=0.002) in maintained BMI groups, respectively. The analyses separately done by gender showed similar results. Conclusions: Decrease of SMI during chemotherapy was a significantly poor prognostic factor for survival regardless of BMI changes.

scholarly journals Impact of Grip Strength in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2146 ◽  
Author(s):  
Kei Endo ◽  
Hidekatsu Kuroda ◽  
Jo Kanazawa ◽  
Takuro Sato ◽  
Yudai Fujiwara ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Skeletal Muscle ◽  
Muscle Strength ◽  
Grip Strength ◽  
Cox Proportional Hazards Model ◽  
University Hospital ◽  
Poor Prognostic Factor ◽  
Skeletal Muscle Index ◽  
Increased Risk ◽  
The Impact

Although sarcopenia is characterized by a loss of muscle strength and skeletal muscle mass, few studies have evaluated the effect of muscle strength on hepatocellular carcinoma (HCC) patients. We evaluated the impact of sarcopenia-related factors (grip strength (GS) and the skeletal muscle index (SMI)) on the survival among lenvatinib-treated unresectable HCC (u-HCC) patients. This single-center cohort study was conducted at a university hospital. The study population included 63 lenvatinib-treated u-HCC patients managed between April 2018 and April 2020. A decreased GS and decreased SMI were found in 21 (33.3%) and 22 (34.9%) patients, respectively. The overall survival (OS) of the normal GS group was significantly higher than that of the decreased GS group, while that of the normal and decreased SMI groups did not differ markedly. There were no significant differences in the progression-free survival between the normal GS and decreased GS groups or the normal SMI and decreased SMI groups. A multivariate Cox proportional hazards model showed that modified albumin-bilirubin-grade (mALBI) 2b (hazard ratio (HR) 4.39) and a decreased GS (HR 3.55) were independently associated with an increased risk of poor prognosis. In addition to the hepatic functional reserve, a decreased GS was a poor prognostic factor in lenvatinib-treated u-HCC patients.

scholarly journals Correlation of the Aryl Hydrocarbon Receptor with FSHR in Ovarian Cancer Patients

2019 ◽  
Vol 20 (12) ◽  
pp. 2862 ◽  
Author(s):  
Eileen Deuster ◽  
Doris Mayr ◽  
Anna Hester ◽  
Thomas Kolben ◽  
Christine Zeder-Göß ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Aryl Hydrocarbon Receptor ◽  
Cancer Patients ◽  
Functional Role ◽  
Clear Cell ◽  
Staining Intensity ◽  
Prognostic Impact ◽  
Histological Subtypes ◽  
Aryl Hydrocarbon ◽  
The Impact

Expression of the aryl hydrocarbon receptor (AhR) has been described in various tumor entities from different organs. However, its role in ovarian cancer has not been thoroughly investigated. We aimed to elucidate the prognostic impact of AhR, its correlation with the follicle-stimulating hormone receptor (FSHR), and their functional role in ovarian cancer. By immunohistochemistry, AhR staining was analyzed in a subset of 156 samples of ovarian cancer patients. AhR staining was assessed in the nucleus and the cytoplasm using the semi-quantitative immunoreactive score (IRS), and the scores were grouped into high- and low-level expression. AhR expression was detected in all histological subtypes, with clear cell ovarian cancer displaying the highest staining intensity. Low cytoplasmic expression of AhR was associated with longer overall survival (median 183.46 vs. 85.07 months; p = 0.021). We found a positive correlation between AhR and FSHR (p = 0.005). Ovarian cancer patients with high cytoplasmic AhR and concurrent FSHR expression had the worst outcome (median 69.72 vs. 43.32 months; p = 0.043). Consequently, low cytoplasmic AhR expression seems to be associated with improved survival in ovarian cancer patients. Our data suggest that AhR and FSHR levels correlate with each other, and their concurrent expression was observed in ovarian cancer patients with the worst outcome. Further investigation of the interaction of both receptors and their functional role might better predict the impact of endocrine therapy in ovarian cancer.

scholarly journals Association between Skeletal Muscle Loss and the Response to Neoadjuvant Chemotherapy for Breast Cancer

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1806
Author(s):  
Byung Min Lee ◽  
Yeona Cho ◽  
Jun Won Kim ◽  
Sung Gwe Ahn ◽  
Jee Hung Kim ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Skeletal Muscle ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Muscle Loss ◽  
Breast Cancer Patients ◽  
Skeletal Muscle Index ◽  
Skeletal Muscle Loss ◽  
The Impact ◽  
Response To Neoadjuvant Chemotherapy

There are no means to predict patient response to neoadjuvant chemotherapy (NAC); the impact of skeletal muscle loss on the response to NAC remains undefined. We investigated the association between response to chemotherapy and skeletal muscle loss in breast cancer patients. Patients diagnosed with invasive breast cancer who were treated with NAC, surgery, and radiotherapy were analyzed. We quantified skeletal muscle loss using pre-NAC and post-NAC computed tomography scans. The response to treatment was determined using the Response Evaluation Criteria in Solid Tumors. We included 246 patients in this study (median follow-up, 28.85 months). The median age was 48 years old (interquartile range 42–54) and 115 patients were less than 48 years old (46.7%). Patients showing a complete or partial response were categorized into the responder group (208 patients); the rest were categorized into the non-responder group (38 patients). The skeletal muscle mass cut-off value was determined using a receiver operating characteristic curve; it showed areas under the curve of 0.732 and 0.885 for the pre-NAC and post-NAC skeletal muscle index (p < 0.001 for both), respectively. Skeletal muscle loss and cancer stage were significantly associated with poor response to NAC in locally advanced breast cancer patients. Accurately measuring muscle loss to guide treatment and delaying muscle loss through various interventions would help enhance the response to NAC and improve clinical outcomes.

scholarly journals P01.08 Sarcopenia as biomarker for immunotherapy outcomes and immune-related adverse events – a systematic review and meta-analysis

2021 ◽  
Vol 9 (Suppl 1) ◽  
pp. A7.1-A7
Author(s):  
S Günther ◽  
P Trinkner ◽  
M von Bergwelt ◽  
D Cordas dos Santos ◽  
S Theurich
Keyword(s):  
Systematic Review ◽  
Skeletal Muscle ◽  
Risk Factor ◽  
Adverse Events ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Lumbar Vertebrae ◽  
Psoas Muscle ◽  
Skeletal Muscle Index ◽  
The Impact

BackgroundSarcopenia is an established risk factor for oncologic treatments like surgical interventions and conventional chemotherapy. However, the impact of sarcopenia on treatment and immune-related adverse events (irAEs) of cancer patients treated with immune checkpoint inhibitors (ICIs) continues to be debated. Therefore, we performed a systematic review and meta-analysis of all published articles evaluating the effects of sarcopenia on survival outcomes and irAEs of patients undergoing ICI treatment.Materials and MethodsIn analogy to the Cochrane guidelines for systematic reviews, we performed a systematic literature search including all published articles in PubMed until February 2021 for the key terms ‘sarcopenia’ or ‘sarcopenic obesity’ in combination with several terms for ICI treatments, irrespective of cancer entity and ICI used. Further selection criteria for meta-analysis included defined cut-offs for sarcopenia. Reported outcomes included progression-free survival (PFS), overall survival (OS) and the frequency of irAEs. For the random effects meta-analysis, we used Hazard Ratios (HR) for OS and PFS and Odds Ratios (OR) for occurrence of irAEs with corresponding 95% confidence intervals (95%CI), respectively.ResultsA total of 15 studies with 1,428 patients were selected to be eligible for meta-analysis. To evaluate muscle mass, all studies used CT-derived body composition parameters at the third lumbar vertebrae level and defined sarcopenia by using skeletal muscle index (SMI), psoas muscle index (PMI) or skeletal muscle density (SMD). Sarcopenic patients showed an inferior survival compared to non-sarcopenic patients with a combined HR for PFS with 1.53 (95%CI 1.23-1.91, p= 0.0001) and for OS with 1.6 (95% CI 1.23-2.09, p= 0,0005). Frequency of irAEs did not differ between sarcopenic and non-sarcopenic patients regardless of irAE grade (irAEs of grade≥3: OR 1.14, 95%CI 0.65-2.01, p = 0.64, irAEs of any grade: OR 0.96, 95%CI 0.65-1.42, p = 0.85).ConclusionsThis is the first meta-analysis that assessed sarcopenia in a mixed cohort of cancer patients. It revealed that sarcopenia is an adverse risk factor for survival of patients undergoing ICI treatment without affecting the risk of developing irAEs. Future studies may address sarcopenia as a patient-derived risk factor emphasizing the importance of nutrition and physical activity interventions.Disclosure InformationS. Günther: None. P. Trinkner: None. M. von Bergwelt: None. D. Cordas dos Santos: None. S. Theurich: None.

scholarly journals Impact of Grip Strength in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib

2020 ◽  
Author(s):  
Kei Endo ◽  
Hidekatsu Kuroda ◽  
Jo Kanazawa ◽  
Takuro Sato ◽  
Yudai Fujiwara ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Skeletal Muscle ◽  
Muscle Strength ◽  
Grip Strength ◽  
Cox Proportional Hazards Model ◽  
University Hospital ◽  
Poor Prognostic Factor ◽  
Skeletal Muscle Index ◽  
Increased Risk ◽  
The Impact

Although sarcopenia is characterized by a loss of muscle strength and skeletal muscle mass, few studies have evaluated the effect of muscle strength on hepatocellular carcinoma (HCC) patients. We separately evaluated the impact of sarcopenia-related factors (grip strength [GS] and the skeletal muscle index [SMI]) on the survival among lenvatinib-treated unresectable HCC (u-HCC) patients. This single-center cohort study was conducted at a university hospital. The study population included 63 lenvatinib-treated u-HCC patients managed between April 2018 and April 2020. A decreased GS and decreased SMI were found in 21 (33.3%) and 22 (34.9%) patients, respectively. The overall survival (OS) of the normal GS group was significantly higher than that of the decreased GS group, while that of the normal and decreased SMI groups did not differ markedly. There were no significant differences in the progression-free survival between the normal GS and decreased GS groups or the normal SMI and decreased SMI groups. A multivariate Cox proportional hazards model showed that ALBI2b (hazard ratio [HR] 4.39) and a decreased GS (HR 3.55) were independently associated with an increased risk of poor prognosis. In addition to the hepatic functional reserve, a decreased GS was a poor prognostic factor in lenvatinib-treated u-HCC patients.

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