Bone Mineral Density as a Risk Factor for Patients Undergoing Surgery for Hepatocellular Carcinoma
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We have reported the impact of sarcopenia and body composition on patients undergoing hepatectomy for hepatocellular carcinoma (HCC). However, the impact of bone mineral density (BMD) on outcomes after hepatectomy for HCC and correlation with other parameters including sarcopenia are unclear.
We retrospectively analyzed 465 patients who underwent primary hepatectomy for HCC between April 2005 and March 2015. We analyzed the plain CT images at the level of the eleventh thoracic vertebra with the region of interest and defined as preoperative BMD.
In this cohort, male (n = 367) and female (n = 98) patients showed significant heterogeneity in age, body composition markers, tumor factors, peri-operative parameters and so on. The median preoperative BMD in male and female patients was 155 and 139 HU, respectively (P = 0.005). BMD was negatively correlated with age in female (r = −0.590, P < 0.001) and intramuscular adipose tissue content in both male and female (r = −0.332 and −0.359, respectively, P < 0.001). For males, BMD < 160 HU was associated with worse cancer-specific survival post-hepatectomy (P = 0.015). In contrast, females were not (P = 0.135). For male patients, multivariate analysis identified low BMD as an independent risk factor for death (hazard ratio 1.720, 95% confidence interval 1.038–2.922, P = 0.035) after hepatectomy for HCC.
Preoperative low BMD was an independent risk factor for cancer-specific mortality after hepatectomy for HCC.
Area under the curve
Bone mineral density
Dual-energy X-ray absorptiometry
- HBs Ag
Hepatitis B virus antigen
- HCV Ab
Hepatitis C virus antibody
Intramuscular adipose tissue content
Psoas muscle index
Receiver operating characteristic
Region of interest
Eleventh thoracic vertebra
Visceral-to-subcutaneous adipose tissue ratio
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 23.Kobayashi A, Kaido T, Hamaguchi Y, et al (2017) Impact of sarcopenic obesity on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg. https://doi.org/10.1097/sla.0000000000002555