Department of Radiology, The Third Xiangya Hospital of Central South University, Changsha, China.
School of Mathematics and Statistics of Central South University, Changsha, China.
Clin Nutr. 2020 Oct;39(10):3132-3139. doi: 10.1016/j.clnu.2020.01.021. Epub 2020 Feb 4.
BACKGROUND & AIMS: Sarcopenia is associated with a higher rate of complications and is an independent predictor of poor outcomes in cirrhosis. The aim of this study was to investigate the association between sarcopenia and the risk of hepatocellular carcinoma (HCC) among patients with cirrhosis.
Four hundred and ninety-two patients with cirrhosis and no evidence of HCC from 2008 to 2017 were enrolled, who had baseline abdominal computed tomography (CT) analyzed for identification of sarcopenia according to the previously established sex-specific cutoffs. The main endpoint of follow-up was the occurrence of HCC.
The majority of patients were male (365/492, 74.2%), and sarcopenia were present in 238 (48.4%) patients at baseline. During a median follow-up of 3.6 years, 54 (11.0%) patients developed HCC. The cumulative incidence of HCC was significantly higher in male patients with sarcopenia than those without sarcopenia (P = 0.001), but not in female patients (P = 0.26). Multivariate Cox regression analysis showed that sarcopenia (hazard ratio [HR], 2.27; 95% confidence interval [CI], 1.09-4.74) was a significant independent factor for HCC development in male patients with cirrhosis, which was consistently identified through competing-risk analysis (subdistribution HR, 2.20; 95% CI, 1.02-4.72). After propensity score matching, male cirrhotic patients with sarcopenia still had a higher risk of HCC than those without sarcopenia (P = 0.02).
Sarcopenia is associated with an increased risk of developing HCC among male patients with cirrhosis. Therefore, nutritional assessment and necessary interventions in specific cirrhotic patients need to be valued.
肌少症与并发症发生率较高相关，是肝硬化不良结局的独立预测因素。本研究旨在探讨肝硬化患者肌少症与肝细胞癌（HCC）风险之间的关系。
纳入 2008 年至 2017 年间无 HCC 证据的 492 例肝硬化患者，根据先前建立的性别特异性截断值，对基线腹部计算机断层扫描（CT）进行分析以确定肌少症。随访的主要终点是 HCC 的发生。
大多数患者为男性（365/492，74.2%），基线时 238 例（48.4%）患者存在肌少症。在中位数为 3.6 年的随访期间，54 例（11.0%）患者发生 HCC。男性肌少症患者的 HCC 累积发生率明显高于无肌少症患者（P=0.001），但女性患者无差异（P=0.26）。多因素 Cox 回归分析显示，肌少症（风险比[HR]，2.27；95%置信区间[CI]，1.09-4.74）是肝硬化男性患者 HCC 发生的显著独立因素，这在竞争风险分析中得到了一致验证（亚分布 HR，2.20；95%CI，1.02-4.72）。经过倾向评分匹配后，肌少症的肝硬化男性患者 HCC 发生风险仍高于无肌少症患者（P=0.02）。
肌少症与肝硬化男性患者 HCC 发生风险增加相关。因此，需要重视对特定肝硬化患者进行营养评估和必要的干预。
