P1827 - Trajectory of Cancer-Associated Weight Loss in Patients With Hepatocellular Carcinoma Is Associated With Prognosis

Samuel Phen, MD¹, Nirali Desai, BS¹, Sukul Mittal, BS¹, Girija Hariharan, MD¹, George Cholankeril, MD², Adam Yopp, MD¹, Jorge Marrero, MD, MS³, Puneeth Iyengar, MD, PhD¹, Rodney Infante, MD, PhD¹, Amit G. Singal, MD, MS⁴, Nicole E. Rich, MD, MS^4
1UT Southwestern Medical Center, Dallas, TX; ²Baylor College of Medicine, Houston, TX; ³University of Pennsylvania, Philadelphia, PA; ⁴University of Texas Southwestern Medical Center, Dallas, TX

Introduction: Cancer cachexia, a clinical syndrome of wasting defined by specific weight loss criteria, is associated with functional decline and poorer outcomes in various cancers, including hepatocellular carcinoma (HCC). There are few data on weight loss trajectory and its impact on survival in patients with HCC.

Methods: We performed a retrospective cohort study of consecutive patients diagnosed with HCC at two U.S. health systems between 2008-2018. Cachexia (CCX) was defined as >5% weight loss (or >2% weight loss if BMI < 20 kg/m²), according to international consensus definitions. Patients were classified into four groups based on weight loss trajectory, assessed by percent weight loss 6 months prior to HCC diagnosis and weight loss 6 months after HCC diagnosis: Group 1: CCX - /CCX -; Group 2: CCX + / CCX -; Group 3: CCX - /CCX +; Group 4: CCX + / CCX +. We used multivariable Cox proportional hazard models to identify factors associated with overall survival and log-rank tests to compare survival between groups.

Results: We identified 507 patients meeting inclusion criteria; 52.1%, 27.4%, 16.2% and 4.3% in Groups 1, 2, 3, and 4, respectively. Most patients were Child Pugh class A (60.8%) or B (32.5%). Groups 1 and 2 had a higher proportion of tumors diagnosed at an early stage (BCLC 0/A) compared to groups 3 and 4 (72.6% and 66.7% vs 54.0% and 36.7%; p< 0.001). Similarly, a higher proportion of patients in groups 1 received surgical treatment compared to those in groups 2, 3 and 4 (33.6% vs 26.3%, 30.2% and 27.3%; p< 0.001). Among the subset of patients who underwent locoregional therapy (n=256), there was no significant difference in objective response rates between the 4 groups (p=0.50). Overall survival was best in group 1 patients (34.3 months), intermediate in groups 2 and 3 (20.3 and 17.3 months respectively) and worst in group 4 patients (11.4 months) (p< 0.001). In multivariable analysis, patients in group 4 had worse overall survival compared to group 1 after adjusting for age, sex, race, Child Pugh class, tumor stage, and HCC treatment modality (aHR 1.71, 95%CI 1.01 – 2.88), whereas survival differences for groups 2 (aHR 1.17, 95%CI 0.85 – 1.62) and 3 (aHR 1.11, 95%CI 0.84 - 1.45) were no longer statistically significant.

Discussion: Trajectory of cancer-associated weight loss is associated with lower rates of curative treatment receipt and worse survival in patients with HCC.



Disclosures:


Samuel Phen, MD¹, Nirali Desai, BS¹, Sukul Mittal, BS¹, Girija Hariharan, MD¹, George Cholankeril, MD², Adam Yopp, MD¹, Jorge Marrero, MD, MS³, Puneeth Iyengar, MD, PhD¹, Rodney Infante, MD, PhD¹, Amit G. Singal, MD, MS⁴, Nicole E. Rich, MD, MS⁴. P1827 - Trajectory of Cancer-Associated Weight Loss in Patients With Hepatocellular Carcinoma Is Associated With Prognosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.