Abstract
Sarcopenia impairs survival in patients with hepatocellular carcinoma (HCC). This study aimed to clarify the factors that contribute to decreased skeletal muscle volume in patients with HCC. The third lumbar vertebra skeletal muscle index (L3 SMI) in 351 consecutive patients with HCC was calculated to identify sarcopenia. Sarcopenia was defined as an L3 SMI value ≤ 29.0 cm2/m2 for women and ≤ 36.0 cm2/m2 for men. The factors affecting L3 SMI were analyzed by multiple linear regression analysis and tree-based models. Of the 351 HCC patients, 33 were diagnosed as having sarcopenia and showed poor prognosis compared with non-sarcopenia patients (p = 0.007). However, this significant difference disappeared after the adjustments for age, sex, Child–Pugh score, maximum tumor size, tumor number, and the degree of portal vein invasion by propensity score matching analysis. Multiple linear regression analysis showed that age (p = 0.015) and sex (p < 0.0001) were significantly correlated with a decrease in L3 SMI. Tree-based models revealed that sex (female) is the most significant factor that affects L3 SMI. In male patients, L3 SMI was decreased by aging, increased Child–Pugh score (≥56 years), and enlarged tumor size (<56 years). Maintaining liver functional reserve and early diagnosis and therapy for HCC are vital to prevent skeletal muscle depletion and improve the prognosis of patients with HCC.
Highlights
IntroductionPatients with Hepatocellular carcinoma (HCC) have a poor clinical course as the prognosis is strongly affected by liver functional reserve and clinical cancer stage [1,2]
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide
Skeletal muscle volume depletion assessed by computed tomography (CT) predicts poor prognosis of all cancer stages [11], and for sorafenib-treated patients with HCC [12]
Summary
Patients with HCC have a poor clinical course as the prognosis is strongly affected by liver functional reserve and clinical cancer stage [1,2]. The recurrence rate of HCC is extremely high, which is associated with the poor prognosis [3]. Skeletal muscle depletion or sarcopenia, initially defined as the loss of skeletal muscle mass that occurs with aging [5], has garnered attention as a new and promising prognostic factor for various malignancies, including HCC [6,7,8,9,10]. Skeletal muscle volume depletion assessed by computed tomography (CT) predicts poor prognosis of all cancer stages [11], and for sorafenib-treated patients with HCC [12]. Sarcopenia and rapid skeletal muscle depletion are involved in worse survival in Nutrients 2017, 9, 1054; doi:10.3390/nu9101054 www.mdpi.com/journal/nutrients
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