title: Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma.
abstract: OBJECTIVE
  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.
authors.affiliation: *Department of Oncology, Cross Cancer Institute †Division of Gastroenterology & Liver Unit, University of Alberta Hospital, Edmonton, AB, Canada ‡Department of Nutrition, Food and Exercise Sciences, The Florida State University, Tallahassee, FL.
authors.forename: Judith
authors.initials: J
authors.lastname: Meza-Junco
authors.forename: Aldo J
authors.initials: AJ
authors.lastname: Montano-Loza
authors.forename: Vickie E
authors.initials: VE
authors.lastname: Baracos
authors.forename: Carla M M
authors.initials: CM
authors.lastname: Prado
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bain
authors.forename: Crystal
authors.initials: C
authors.lastname: Beaumont
authors.forename: Nina
authors.initials: N
authors.lastname: Esfandiari
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Lieffers
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sawyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009752:Nutritional Status; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000473:pathology*; D016019:Survival Analysis