Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Br J Surg. 2013 Oct;100(11):1523-30. doi: 10.1002/bjs.9258.
Sarcopenia was identified recently as a poor prognostic factor in patients with cancer. The present study investigated the effect of sarcopenia on short- and long-term outcomes following partial hepatectomy for hepatocellular carcinoma (HCC), and aimed to identify prognostic factors.
Data were collected retrospectively for all consecutive patients who underwent hepatectomy for HCC with curative intent between January 2004 and December 2009. Patients were assigned to one of two groups according to the presence or absence of sarcopenia, assessed by computed tomographic measurement of muscle mass at the level of the third lumbar vertebra. Clinicopathological, surgical outcome and long-term survival data were analysed.
Sarcopenia was present in 75 (40·3 per cent) of 186 patients, and was significantly correlated with female sex, lower body mass index and liver dysfunction, as indicated by abnormal serum albumin levels and indocyanine green retention test at 15 min values. In patients with, and without sarcopenia, the 5-year overall survival rate was 71 and 83·7 per cent respectively, and the 5-year recurrence-free survival rate was 13 and 33·2 per cent respectively. Multivariable analysis revealed that reduced skeletal muscle mass was predictive of an unfavourable prognosis.
Sarcopenia was predictive of worse overall survival even when adjusted for other known predictors in patients with HCC after partial hepatectomy.
肌少症最近被确定为癌症患者的一个不良预后因素。本研究调查了肌少症对肝细胞癌（HCC）患者行部分肝切除术后短期和长期结局的影响，并旨在确定预后因素。
回顾性收集了 2004 年 1 月至 2009 年 12 月期间因 HCC 接受根治性肝切除术的所有连续患者的数据。根据第三腰椎水平肌肉量的计算机断层扫描测量，将患者分为有肌少症和无肌少症两组。分析了临床病理、手术结果和长期生存数据。
186 例患者中有 75 例（40.3%）存在肌少症，且与女性、较低的体重指数和肝功能异常显著相关，表现为血清白蛋白水平异常和 15 分钟时的吲哚菁绿滞留试验值升高。有肌少症和无肌少症患者的 5 年总生存率分别为 71%和 83.7%，5 年无复发生存率分别为 13%和 33.2%。多变量分析显示，骨骼肌质量减少与预后不良相关。
即使在调整了部分肝切除术后其他已知的预测因素后，肌少症也可预测 HCC 患者的总体生存情况更差。
