Gender Different Impacts of Muscle Mass and Adipose Tissue on Patients With Hepatocellular Carcinoma Undergoing Surgical Resection

ABSTRACT Background & Aims Body composition is an objective assessment reflecting nutritional status and is highly gender different. Surgical resection, the standard treatment for early‐stage hepatocellular carcinoma (HCC), is an energy‐consuming major operation that would affect body composition. However, the impacts of body composition on the post‐operative prognosis of HCC are still uncertain. In this study, we aimed to investigate surgery‐related changes in body composition and the impacts on clinical outcomes of HCC after surgical resection distinguished by gender. Method From January 2013 to December 2018, 401 consecutive patients who received surgical resection for HCC in Taipei Veterans General Hospital were retrospectively reviewed. Cross areas of adipose and muscle mass were measured at L3 vertebral level from peri‐operative computed tomography by Slice‐O‐matic software; body composition indices were thus calculated. Factors associated with survivals were analysed. Results Body composition indices did not change significantly after surgical resection of HCC in both males and females. Higher pre‐operative intramuscular adipose tissue index (IMATI) (hazard ratio [HR]: 2.059, p = 0.002) and lower ratio of subcutaneous to visceral adipose tissue index (SATI/VATI) (HR: 1.681, p = 0.028) were independent predictors of worse overall survival (OS) in male patients. In females, higher pre‐operative IMATI (HR: 3.053, p = 0.001) was the only body composition‐related factor predicting OS. Conclusion Surgical resection contributed minor changes in body composition in patients with early HCC. Myosteatosis and subcutaneous to visceral fat ratio were survival predictors in male patients, but myosteatosis was the only body composition‐predictor of survival in females.