World Journal of Surgery

, Volume 43, Issue 3, pp 920–928 | Cite as

Bone Mineral Density as a Risk Factor for Patients Undergoing Surgery for Hepatocellular Carcinoma

  • Yosuke Miyachi
  • Toshimi KaidoEmail author
  • Siuan Yao
  • Hisaya Shirai
  • Atsushi Kobayashi
  • Yuhei Hamaguchi
  • Naoko Kamo
  • Shintaro Yagi
  • Shinji Uemoto
Original Scientific Report



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


Confidence interval


Computed tomography


Dual-energy X-ray absorptiometry

HBs Ag

Hepatitis B virus antigen


Hepatocellular carcinoma


Hepatitis C virus antibody


Hounsfield unit


Intramuscular adipose tissue content


Interquartile range


Psoas muscle index


Receiver operating characteristic


Region of interest


Standard deviation


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.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Yosuke Miyachi
    • 1
  • Toshimi Kaido
    • 1
    Email author
  • Siuan Yao
    • 1
  • Hisaya Shirai
    • 1
  • Atsushi Kobayashi
    • 1
  • Yuhei Hamaguchi
    • 1
  • Naoko Kamo
    • 1
  • Shintaro Yagi
    • 1
  • Shinji Uemoto
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan

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