Sarcopenia negatively impacts long‐term outcomes following curative resection for hepatocellular carcinoma: Results of a long‐term follow‐up study

Background/Purpose Sarcopenia is a surrogate marker of frailty and is common in cirrhosis. Although sarcopenia is associated with worse outcomes following liver transplantation, its long-term impact following hepatectomy for hepatocellular carcinoma (HCC) is less well known. We evaluated the prevalence and prognostic impact of sarcopenia in a cohort of patients undergoing resection for HCC. Methods Data were collected retrospectively on consecutive patients undergoing hepatectomy for HCC between June 1998 and December 2014 at Auckland City Hospital. The skeletal muscle index (SMI) was calculated using the total skeletal muscle area (SMA) at the third lumbar vertebrae on pre-operative computed tomography or magnetic resonance imaging. The clinicopathological and surgical characteristics of sarcopenic and nonsarcopenic groups were compared and outcomes including overall survival (OS) and recurrence-free survival (RFS) were assessed. Results About 147 patients underwent hepatectomy for HCC and followed until death or a minimum of 5 years (up to 19 years), 40 were sarcopenic (27%). Sarcopenia correlated significantly (P < .01) with older age and larger tumour size. Sarcopenia was a predictor of worse OS (P < .01), liver cancer-specific survival (P = .022) and RFS at 5 years (P = .025). RFS rates at 5 years were 25.6% and 43.8% respectively. Sarcopenia was an independent predictor of survival on multivariate analysis (HR 1.84, 95% CI 1.11-3.05, P = .019). Conclusion Sarcopenia predicted worse OS and RFS in patients undergoing hepatectomy for HCC. In the pre-operative assessment, sarcopenia may provide an objective marker of the patient's general health, facilitating the implementation of strategies to optimise muscle mass, thereby improving patient outcomes.