Takada Hitomi, Osawa Leona, Komiyama Yasuyuki, Muraoka Masaru, Suzuki Yuichiro, Sato Mitsuaki, Kobayashi Shoji, Yoshida Takashi, Takano Shinichi, Maekawa Shinya, Enomoto Nobuyuki
Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan.
PLoS One. 2025 Apr 24;20(4):e0307458. doi: 10.1371/journal.pone.0307458. eCollection 2025.
The significance of imaging-based assessment of muscles and malnutrition in patients with primary hepatocellular carcinoma (HCC) remains unclear. This study aimed to elucidate the prognostic role of the combination of Low Muscle Volume and Value (LMVV) and malnutrition.
A total of 714 Child-Pugh grade A/ B patients with first-diagnosed HCC were enrolled, and analyzed factors associated with overall survival. LMVV was defined using psoas muscle mass index and computed tomography values of multifidus muscle at the level of the third lumbar vertebra. We used hypoalbuminemia, Child-Pugh grade B, Subjective Global Assessment (SGA) grade B/C, and Royal Free Hospital Nutrition Prioritizing Tool (RFH-NPT) score > 2 as malnutrition factors in this study.
At baseline, 29% showed LMVV, and 59% met one or more of the malnutrition criteria. No items meeting the criteria of LMVV and malnutrition was observed in 41%, 1 of them was found in 29%, and both were found in 29%. The number of items meeting criteria was an independent factor for a shorter survival. The frequency of liver-related deaths did not differ by presence of LMVV alone, while it was associated with malnutrition. In contrast, the incidence of other types of deaths was influenced by LMVV and malnutrition.
The combination of LMVV and malnutrition is a prognostic factor in patients with primary HCC.
基于影像学评估原发性肝细胞癌（HCC）患者的肌肉状况和营养不良的意义仍不明确。本研究旨在阐明低肌肉量值（LMVV）与营养不良联合评估的预后作用。
共纳入714例初诊为HCC的Child-Pugh A/B级患者，分析与总生存期相关的因素。LMVV通过腰大肌质量指数和第三腰椎水平多裂肌的计算机断层扫描值来定义。在本研究中，我们将低白蛋白血症、Child-Pugh B级、主观全面评定法（SGA）B/C级以及皇家自由医院营养优先排序工具（RFH-NPT）评分>2作为营养不良因素。
基线时，29%的患者表现为LMVV，59%的患者符合一项或多项营养不良标准。41%的患者未观察到符合LMVV和营养不良标准的项目，29%的患者有其中一项符合标准，29%的患者两项均符合标准。符合标准的项目数量是生存期较短的独立因素。单纯存在LMVV时，肝相关死亡的发生率无差异，而与营养不良有关。相比之下，其他类型死亡的发生率受LMVV和营养不良的影响。
LMVV与营养不良的联合是原发性HCC患者的一个预后因素。
