Departments of *Digestive and Hepatobiliary Surgery †Radiology, Henri-Mondor Hospital, AP-HP, Créteil, France ‡Université Paris Est, Faculté de Médecine Créteil, Créteil, France; and §INSERM, U 955, Equipe 18, Creteil, F-94010, France.
Ann Surg. 2015 Jun;261(6):1173-83. doi: 10.1097/SLA.0000000000000743.
To evaluate the prevalence of sarcopenia among European patients with resectable hepatocellular carcinoma (HCC) and to assess its prognostic impact on overall and disease-free survival.
Identification of preoperative prognostic factors in liver surgery for HCC is required to better select patients and improve survival. Recent studies have shown that preoperative discrimination of patients with low skeletal muscle mass (sarcopenic patients) using computed tomography was associated with morbidity and mortality after liver and colorectal surgery. Assessment of sarcopenia could be used to evaluate patients before hepatectomy for HCC.
All consecutive patients who underwent hepatectomy for HCC in our institution, between February 2006 and September 2012, were included. Univariate and multivariate analyses evaluating prognostic factors of postoperative mortality and cancer recurrence were performed, including preoperative, surgical, and histopathological factors.
Among 198 patients who underwent hepatectomy for HCC, 109 patients had an available computed tomographic scan and represent the study cohort. After a median follow-up of 21.23 months, 27 patients (24.8%) died. There were 20 deaths among the 59 patients who had sarcopenia and only 7 deaths in the nonsarcopenic group. Sarcopenic patients had significantly shorter median overall survival than nonsarcopenic patients (52.3 months vs 70.3 months; P = 0.015). On multivariate analysis, sarcopenia was found to be an independent predictor of poor overall survival (hazard ratio = 3.19; P = 0.013) and disease-free survival (hazard ratio = 2.60; P = 0.001).
Sarcopenia was found to be a strong and independent prognostic factor for mortality after hepatectomy for HCC in European patients and could be used to evaluate eligibility of patients with HCC before surgery.
评估可切除肝细胞癌（HCC）欧洲患者的肌肉减少症患病率，并评估其对总生存期和无病生存期的预后影响。
需要识别 HCC 肝切除术前的预后因素，以便更好地选择患者并提高生存率。最近的研究表明，使用计算机断层扫描术术前区分低骨骼肌量（肌肉减少症患者）与肝和结直肠手术后的发病率和死亡率相关。对肌肉减少症的评估可用于评估 HCC 肝切除术前的患者。
纳入 2006 年 2 月至 2012 年 9 月期间在我院接受 HCC 肝切除术的所有连续患者。进行了单因素和多因素分析，以评估术后死亡率和癌症复发的预后因素，包括术前、手术和组织病理学因素。
在 198 例接受 HCC 肝切除术的患者中，有 109 例患者有可用的计算机断层扫描结果，代表研究队列。中位随访 21.23 个月后，27 例（24.8%）患者死亡。59 例肌肉减少症患者中有 20 例死亡，而非肌肉减少症患者中仅有 7 例死亡。肌肉减少症患者的总生存期明显短于非肌肉减少症患者（52.3 个月比 70.3 个月；P=0.015）。多因素分析显示，肌肉减少症是总生存期不良的独立预测因素（风险比=3.19；P=0.013）和无病生存期（风险比=2.60；P=0.001）。
在欧洲 HCC 肝切除术后患者中，肌肉减少症被发现是死亡率的一个强烈且独立的预后因素，可用于评估手术前 HCC 患者的手术适应证。
