Lee Pei-Chang, Cheng Tsung-Yi, Ho Chun-Ting, Huang Kuo-Wei, Chau Gar-Yang, Huang Yi-Hsiang, Huo Teh-Ia, Hou Ming-Chih, Wu Jaw-Ching, Su Chien-Wei
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Liver Int. 2025 Feb;45(2):e16237. doi: 10.1111/liv.16237.
BACKGROUND & AIMS: Body composition is an objective assessment reflecting nutritional status and is highly gender different. Surgical resection, the standard treatment for early-stage hepatocellular carcinoma (HCC), is an energy-consuming major operation that would affect body composition. However, the impacts of body composition on the post-operative prognosis of HCC are still uncertain. In this study, we aimed to investigate surgery-related changes in body composition and the impacts on clinical outcomes of HCC after surgical resection distinguished by gender.
From January 2013 to December 2018, 401 consecutive patients who received surgical resection for HCC in Taipei Veterans General Hospital were retrospectively reviewed. Cross areas of adipose and muscle mass were measured at L3 vertebral level from peri-operative computed tomography by Slice-O-matic software; body composition indices were thus calculated. Factors associated with survivals were analysed.
Body composition indices did not change significantly after surgical resection of HCC in both males and females. Higher pre-operative intramuscular adipose tissue index (IMATI) (hazard ratio [HR]: 2.059, p = 0.002) and lower ratio of subcutaneous to visceral adipose tissue index (SATI/VATI) (HR: 1.681, p = 0.028) were independent predictors of worse overall survival (OS) in male patients. In females, higher pre-operative IMATI (HR: 3.053, p = 0.001) was the only body composition-related factor predicting OS.
Surgical resection contributed minor changes in body composition in patients with early HCC. Myosteatosis and subcutaneous to visceral fat ratio were survival predictors in male patients, but myosteatosis was the only body composition-predictor of survival in females.
身体组成是反映营养状况的客观评估指标，且存在显著性别差异。手术切除是早期肝细胞癌（HCC）的标准治疗方法，这是一项消耗能量的大型手术，会影响身体组成。然而，身体组成对HCC术后预后的影响仍不明确。在本研究中，我们旨在探讨手术相关的身体组成变化以及按性别区分的手术切除后身体组成对HCC临床结局的影响。
回顾性分析2013年1月至2018年12月在台北荣民总医院连续接受HCC手术切除的401例患者。使用Slice-O-matic软件通过围手术期计算机断层扫描测量L3椎体水平的脂肪和肌肉质量的横截面积；从而计算身体组成指数。分析与生存相关的因素。
男性和女性HCC手术切除后身体组成指数均无显著变化。术前较高的肌内脂肪组织指数（IMATI）（风险比[HR]：2.059，p = 0.002）和较低的皮下与内脏脂肪组织指数比（SATI/VATI）（HR：1.681，p = 0.028）是男性患者总体生存（OS）较差的独立预测因素。在女性中，术前较高的IMATI（HR：3.053，p = 0.001）是唯一预测OS的身体组成相关因素。
手术切除对早期HCC患者身体组成的影响较小。肌脂肪变性和皮下与内脏脂肪比是男性患者的生存预测指标，但肌脂肪变性是女性患者生存的唯一身体组成预测指标。
