title: Adverse impact of low skeletal muscle index on the prognosis of hepatocellular carcinoma after hepatic resection.
abstract: BACKGROUND
  Skeletal muscle depletion predicts poor prognosis of patients with certain cancers. However, the correlation between low skeletal muscle index (SMI) and the prognosis of hepatocellular carcinoma (HCC) is not well understood.
  
  
  METHODS
  To determine their influence on prognosis, skeletal muscle index (SMI) and visceral fat area (VFA) were measured using computed tomography at the level of the third lumbar vertebra of 195 patients who underwent primary hepatectomy for hepatocellular carcinoma (HCC). We defined sarcopenia using cutoff values for SMI as 43.75 cm(2)/m(2) and 41.10 cm(2)/m(2) for males and females, respectively.
  
  
  RESULTS
  Sarcopenia was present in 89 of 195 (45.6%) patients and correlated significantly (P < 0.001) with female sex, low body mass index (BMI), low subcutaneous fat area, low VFA, and low serum albumin levels. There was a trend indicating the association of sarcopenia with poor cumulative recurrence rate (CRR) (P = 0.13). In patients with BMI ≥22, CRR was significantly different between patients with or without sarcopenia (19.0 or 35.2 months, respectively, P = 0.03). In contrast, there was no significant difference in patients with BMI ≥22 as a function of VFA (P = 0.47). When the cohort was limited to patients with BMI ≥22, multivariate analysis showed that sarcopenia was a significant independent risk factor for recurrence (hazard ratio = 1.6; 95% confidence interval, 1.1-2.5; P = 0.02).
  
  
  CONCLUSIONS
  Low-SMI was an independent adverse prognostic factor for CRR in patients with BMI ≥22. Therefore, preventing muscle wasting may improve the CRR of patients with HCC.
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan. Electronic address: n.yabusaki@med.nagoya-u.ac.jp.
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Yabusaki
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Radiology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Nakayama
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055948:Sarcopenia / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Body composition; Hepatocellular carcinoma; Prognosis; Sarcopenia