title: Sarcopenia predicts reduced survival in patients with hepatocellular carcinoma at first diagnosis.
abstract: Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis.
  
  
  OBJECTIVE
  To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center.
  
  
  METHODS
  Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively.
  
  
  RESULTS
  Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027).
  
  
  CONCLUSIONS
  This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Begini
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Elia
authors.initials: E
authors.lastname: Gigante
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Antonelli
authors.affiliation: Radiology Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carbonetti
authors.affiliation: Radiology Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Elsa
authors.initials: E
authors.lastname: Iannicelli
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Anania
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Imperatrice
authors.affiliation: Liver Unit, San Camillo Forlanini Hospital, Rome, Italy.
authors.forename: Adriano Maria
authors.initials: AM
authors.lastname: Pellicelli
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Gianfranco Delle
authors.initials: GD
authors.lastname: Fave
authors.affiliation: Digestive and Liver Diseases Department, Sant'Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Marignani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000401:mortality*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D055948:Sarcopenia / Q000000981:diagnostic imaging / Q000401:mortality*; D062606:Tertiary Care Centers; D013997:Time Factors; D014057:Tomography, X-Ray Computed