Adverse impact of low skeletal muscle index on the prognosis of hepatocellular carcinoma after hepatic resection

BACKGROUND: Skeletal muscle depletion predicts poor prognosis of patients with certain cancers. However, the correlation between low skeletal muscle index (SMI) and the prognosis of hepatocellular carcinoma (HCC) is not well understood. METHODS: To determine their influence on prognosis, skeletal muscle index (SMI) and visceral fat area (VFA) were measured using computed tomography at the level of the third lumbar vertebra of 195 patients who underwent primary hepatectomy for hepatocellular carcinoma (HCC). We defined sarcopenia using cutoff values for SMI as 43.75 cm(2)/m(2) and 41.10 cm(2)/m(2) for males and females, respectively. RESULTS: Sarcopenia was present in 89 of 195 (45.6%) patients and correlated significantly (P < 0.001) with female sex, low body mass index (BMI), low subcutaneous fat area, low VFA, and low serum albumin levels. There was a trend indicating the association of sarcopenia with poor cumulative recurrence rate (CRR) (P = 0.13). In patients with BMI ≥22, CRR was significantly different between patients with or without sarcopenia (19.0 or 35.2 months, respectively, P = 0.03). In contrast, there was no significant difference in patients with BMI ≥22 as a function of VFA (P = 0.47). When the cohort was limited to patients with BMI ≥22, multivariate analysis showed that sarcopenia was a significant independent risk factor for recurrence (hazard ratio = 1.6; 95% confidence interval, 1.1-2.5; P = 0.02). CONCLUSIONS: Low-SMI was an independent adverse prognostic factor for CRR in patients with BMI ≥22. Therefore, preventing muscle wasting may improve the CRR of patients with HCC.