Sarcopenia as a Prognostic Index of Nutritional Status in Concurrent Cirrhosis and Hepatocellular Carcinoma

Background and Aims: Abnormal body composition such as severe skeletal muscle depletion or sarcopenia has emerged as an independent predictor of clinical outcomes in a variety of clinical conditions. This study is the first study to report the frequency and prognostic significance of sarcopenia as a marker of nutritional status in patients with hepatocellular carcinoma (HCC). Methods: We analyzed 116 patients with HCC who were consecutively evaluated for liver transplant. Skeletal muscle cross-sectional area was measured by CT. Sarcopenia was defined using previously established cutpoints. Results: Ninety-eight patients were males (85%), and the mean age was 58 +/- 6 years. Sarcopenia was present in 35 patients (30%). By univariate Cox analysis, male sex (HR, 3.84; P = 0.02), lumbar skeletal muscle index (HR, 0.97; P = 0.04), INR (HR, 8.18; P < 0.001), MELD score (HR, 1.19; P < 0.001), Child-Pugh (HR, 3.95; P < 0.001), serum sodium (HR, 0.84; P < 0.001), TNM stage (HR, 2.59; P < 0.001), treatment type (HR, 0.53; P < 0.001), and sarcopenia (HR, 2.27; P = 0.004) were associated with increased risks of mortality. By multivariate Cox regression analysis, only MELD score (HR, 1.08; P = 0.04), Child-Pugh (HR, 2.14; P = 0.005), sodium (HR, 0.89; P = 0.01), TNM stage (HR, 1.92; P < 0.001), and sarcopenia (HR, 2.04; P = 0.02) were independently associated with mortality. Median survival for sarcopenic patients was 16 +/- 6 versus 28 +/- 3 months in nonsarcopenic (P = 0.003). Conclusions: Sarcopenia is present in almost one third of patients with HCC, and constitutes a strong and independent risk factor for mortality. Our results highlight the importance of body composition assessment in clinical practice.