Tesis

Hubungan status performa ECOG dan tebal otot paha dengan sarkopenia pada karsinoma sel hati = Association between ECOG performance status and thigh muscle thickness with sarcopenia in hepatocellular carcinoma.

Latar Belakang: Sarkopenia mempengaruhi prognosis karsinoma sel hati (KSH). Dalam penilaian klasifikasi Barcelona Clinic Liver Cancer (BCLC) terkandung penilaian status performa Eastern Cooperative Oncology Group (ECOG). Status performa ECOG merupakan penilaian aktivitas fisik terkait sarkopenia. Pemeriksaan baku emas sarkopenia pada KSH mahal dan membutuhkan banyak waktu. Pemeriksaan tebal otot paha dapat digunakan sebagai modalitas yang baru. Studi ini bertujuan untuk menilai hubungan antara status performa ECOG dengan sarkopenia pada KSH, mengetahui perbedaan rerata antara tebal otot paha pasien status performa ECOG rendah dengan status performa ECOG tinggi pada KSH, dan mengetahui perbedaan rerata antara tebal otot paha pasien sarkopenia dengan non sarkopenia pada KSH. Metode: Studi ini dilakukan di RS tersier selama Januari – Oktober 2021. Analisis statistik dilakukan untuk memperoleh hubungan antara status performa ECOG, tebal otot paha, dan status sarkopenik pasien KSH. Hasil: Delapan puluh lima subjek pasien KSH (usia median, 52 tahun) dilakukan analisis. Sarkopenia diamati pada 30,6% pasien KSH. Setelah melalui analisis multivariat, status performa ECOG buruk berhubungan dengan sarkopenia pada KSH (adjusted OR = 6,35, IK 95% 2,06-19,60). Terdapat perbedaan signifikan rerata tebal otot paha pasien status performa ECOG rendah dengan status performa ECOG tinggi pada KSH (p < 0,001). Terdapat juga perbedaan signifikan rerata tebal otot paha pasien sarkopenia dan non sarkopenia (p < 0,001). Kesimpulan: Terdapat hubungan antara status performa ECOG tinggi dengan sarkopenia pada KSH (aOR = 6,35, IK 95% 2,06-19,60). Rerata tebal otot paha pasien status performa ECOG rendah lebih besar dibanding dengan status performa ECOG tinggi pada karsinoma sel hati. Rerata tebal otot paha pasien non sarkopenia lebih besar dibanding dengan sarkopenia pada karsinoma sel hati.
Kata Kunci: sarkopenia, KSH, tebal otot paha, IMOS-L3, KGT, ECOG


Background: Sarcopenia affects hepatocellular carcinoma (HCC) prognosis. HCC staging consists of Eastern Cooperative Oncology Group performance status (ECOG-PS). ECOG-PS is an assessment of physical activity related to sarcopenia. Gold standard examinations for sarcopenia in HCC are expensive and timeconsuming. Thigh muscle thickness can be used as a new modality. This study was aimed to explore the association between ECOG-PS with sarcopenia, to seek thigh muscle thickness difference between poor and good performance status, and to know thigh muscle thickness difference between sarcopenic and non-sarcopenic patients with HCC. Methods: The study was conducted in a tertiary hospital during January – October 2021. Statistical analysis was performed to obtain an association between ECOG-PS, thigh muscle thickness, and sarcopenic status of HCC patients. Results: Eighty-five HCC patients (median age, 52 years) were analyzed. Sarcopenia was observed in 30,6% of HCC patients. On multivariate binary regression analysis, a poor ECOG-PS remained independently associated with sarcopenia in HCC (adjusted OR = 6,35, 95% CI 2,06-19,6, p < 0,001). There was a significant difference in thigh muscle thickness between good and poor performance status (p < 0,001). There was also a significant difference in thigh muscle thickness between sarcopenic and non-sarcopenic patients (p < 0,001). Conclusion: There were association between ECOG-PS and sarcopenia in HCC (aOR = 6,35, IK 95% 2,06-19,60). Mean thigh muscle thickness was larger in HCC patients with good ECOG-PS than poor ECOG-PS. Mean thigh muscle thickness was larger in non-sarcopenic HCC patients than sarcopenic ones.
Keywords: sarcopenia, HCC, thigh muscle thickness, L3-SMI, HGS, ECOG