title: Negative impact of low body mass index on liver cirrhosis patients with hepatocellular carcinoma.
abstract: BACKGROUND
  The impact of obesity on the prognosis of hepatocellular carcinoma (HCC) has not been well characterized in a Chinese population. Therefore, the aim of this study was to examine the influence of BMI on the clinicopathological characteristics and mortality of patients with HCC.
  
  
  METHODS
  The study cohort consisted of 379 patients who were diagnosed with HCC at the First Affiliated Hospital of Harbin Medical University between June 2012 and August 2014. Study subjects were divided into two body mass index (BMI) categories: normal weight (BMI <23 kg/m(2)) and overweight (BMI ≥23 kg/m(2)).
  
  
  RESULTS
  Of the 379 patients, 44 (11.6%) were underweight (<18.5 kg/m(2)), 172 (45.4%) had a normal weight (18.5 ≤ BMI < 23.0), 133 (35.1 %) were overweight (23.0 ≤ BMI < 27.5), and 30 (7.9%) were obese (BMI ≥27.5). After a median follow-up time of 296 (range, 15-720) days, 168 (44.3%) patients died with median survival time of 159 (range, 15-690) days. Patients with lower BMIs also exhibited a higher liver-related mortality rate (60.6 vs. 22.7%; p = 1.8 × 10(-13)) and a shorter survival time (353 days vs. 571 days; p = 6.2 × 10(-6)) than patients with higher BMIs. In multivariate analysis, the BMI class was also found to be a significant independent impact factor for overall survival (p = 2.2 × 10(-8)), age, alpha-fetoprotein level, Child-Pugh score, treatment strategy, antiviral treatment, extrahepatic metastasis, and tumor infiltration of the portal vein.
  
  
  CONCLUSIONS
  Our data suggest that lower BMI has a significant impact regarding poor outcomes in patients with HCC. To better understand the impact of BMI on the prognosis of HCC patients, more large-scale cohort studies will be necessary.
authors.affiliation: Department of Infectious Disease, First Affiliated Hospital of Harbin Medical University, No. 23 You Zheng Street, Harbin, 150001, People's Republic of China. Leeqg@163.com.
authors.forename: Qinggang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin, 150086, People's Republic of China. xinghuihushizhang@126.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Xing
authors.affiliation: Department of Gastroenterology, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin, 150086, People's Republic of China. wilmawell@163.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Second Affiliated Hospital of Harbin Medical University, Xuefu Road, Harbin, 150086, People's Republic of China. melanielihui@126.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
mesh_terms: D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate