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Skeletal muscle depletion is an independent prognostic factor for hepatocellular carcinoma

Journal of Gastroenterology volume 50, pages 323–332 (2015)Cite this article

Abstract

Background

Skeletal muscle depletion or sarcopenia has been identified as a poor prognostic factor for various diseases. The aim of this study is to determine whether muscle depletion is a prognostic factor for hepatocellular carcinoma (HCC).

Methods

We evaluated 217 consecutive patients with primary HCC. The skeletal muscle cross-sectional area was measured by computed tomography at the third lumbar vertebra (L3), from which the total body fat-free mass (FFM) and L3 skeletal muscle index (L3 SMI) were obtained. The factors contributing to overall survival (OS) were analyzed by univariate and multivariate Cox proportional hazards model.

Results

In univariate analysis, FFM (P = 0.0422), Child-Pugh classification (P = 0.0058), serum albumin level (P < 0.0001), serum AFP level (P < 0.0001), serum proteins induced by vitamin K absence or antagonist-II level (P < 0.0001), cancer stage (P < 0.0001), and curability of the initial treatment (P < 0.0001) were significantly associated with the prognosis of HCC. Multivariate analysis indicated that FFM (P = 0.0499), albumin level (P = 0.0398), and curability of the initial treatment (P = 0.0008) were independent prognostic factors. Sarcopenia was defined as an L3 SMI value of ≤29.0 cm2/m2 for women and ≤36.0 cm2/m2 for men, and 24 patients (11.1 %) have sarcopenia. Sarcopenic patients showed a significantly lower OS than those without sarcopenia (P = 0.0043). Sarcopenic patients who were overweight (BMI >22) died earlier (P = 0.0129).

Conclusions

Skeletal muscle depletion is an independent prognostic factor. Intervention to prevent muscle wasting might be an effective strategy for improving the outcome of HCC.

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Abbreviations

HCC:

Hepatocellular carcinoma

PEM:

Protein energy malnutrition

CT:

Computed tomography

MRI:

Magnetic resonance imaging

HU:

Hounsfield unit

SMI:

Skeletal muscle index

BMI:

Body mass index

FFM:

Total body fat-free mass

FM:

Total body fat mass

AFP:

Alpha-fetoprotein

PIVKA-II:

Proteins induced by vitamin K absence or antagonist-II

HR:

Hazard ratio

CI:

Confidence interval

BCAA:

Branched-chain amino acids

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Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Soichi Iritani, Kenji Imai, Koji Takai, Tatsunori Hanai, Takayasu Ideta, Tsuneyuki Miyazaki, Atsushi Suetsugu, Makoto Shiraki, Masahito Shimizu & Hisataka Moriwaki

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  1. Soichi Iritani
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  2. Kenji Imai
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Correspondence to Masahito Shimizu.

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Iritani, S., Imai, K., Takai, K. et al. Skeletal muscle depletion is an independent prognostic factor for hepatocellular carcinoma. J Gastroenterol 50, 323–332 (2015). https://doi.org/10.1007/s00535-014-0964-9

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Keywords

  • Hepatocellular carcinoma
  • Skeletal muscle depletion
  • Total body fat-free mass
  • Sarcopenia
  • Prognostic factor