title: Muscle volume loss as a prognostic marker in hepatocellular carcinoma patients treated with sorafenib.
abstract: OBJECTIVE
  To elucidate the clinical significance of muscle wasting in regard to survival of hepatocellular carcinoma (HCC) patients undergoing sorafenib treatment, we evaluated prognostic factors including muscle wasting at the start of sorafenib treatment.
  
  
  METHODS
  We enrolled 93 patients with unresectable HCC (68.3 ± 9.4 years old, 81 men, 12 women, Child-Pugh score 5:6:7 = 69:22:2) who were treated with sorafenib. Muscle wasting was evaluated based on psoas muscle area index (psoas muscle area at level of middle of third lumbar vertebra [cm2] / height [m]2) calculated from computed tomography findings. Previously reported cut-off values for muscle wasting in men and women (4.24 and 2.50 cm2/m2, respectively) were used. Patients were divided into those with (muscle-atrophy group, n = 20) and without (non-atrophy group, n = 73) muscle wasting.
  
  
  RESULTS
  There were no significant differences in regard to etiology, Child-Pugh classification, and tumor-node-metastasis stage between the groups. In contrast, body mass index in the muscle-atrophy group was lower (20.9 ± 2.4 vs. 23.5 ± 3.4, P = 0.003). Although time to progression was not different (median 2.1 vs. 2.8 months, P = 0.242), the 6-, 12-, and 18-month survival rates were worse in the muscle-atrophy group (62.7%, 32.3%, and 32.3% vs. 78.3%, 64.7% and 48.1%, respectively, P = 0.042). In multivariate Cox hazard analysis, des-γ-carboxy prothrombin level (≥100 mAU/mL) (hazard ratio, 2.540; P = 0.018) and positive for muscle wasting (hazard ratio, 2.158; P = 0.032) were significant prognostic factors at the start of sorafenib treatment.
  
  
  CONCLUSIONS
  Muscle wasting is an important prognostic factor in patients treated with sorafenib.
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Koizumi
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Izumoto
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Hidetaro
authors.initials: H
authors.lastname: Ueki
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Kaneto
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kitahata
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Aibiki
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Hideomi
authors.initials: H
authors.lastname: Tomida
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Hiroka
authors.initials: H
authors.lastname: Yamago
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Suga
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Iwasaki
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Mori
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Tsubouchi
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kishida
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ninomiya
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.affiliation: Department of Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawasaki
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
keywords: hepatocellular carcinoma; muscle wasting; pre-sarcopenia; prognosis; sorafenib