Wu Yongjuan, Cheng Guangyuan, Han Jun, Yang Qingsong
Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, No. 136 Jingzhou Street, Xiangcheng District, Xiangyang, 441021, Hubei Province, China.
Clin Exp Med. 2025 May 16;25(1):164. doi: 10.1007/s10238-025-01671-6.
Myosteatosis, characterized by fat infiltration into skeletal muscle, is increasingly recognized as a prognostic factor in hepatocellular carcinoma (HCC), although the results were not consistent. This meta-analysis aimed to summarize impact on overall survival (OS) and progression-free survival (PFS) in patients with HCC.A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting survival outcomes in HCC patients with and without myosteatosis. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 24 retrospective cohort studies involving 7436 HCC patients were included. Myosteatosis was significantly associated with poorer OS (HR: 1.60, 95% CI: 1.40-1.83, p < 0.001, I = 65%) and PFS (HR: 1.53, 95% CI: 1.33-1.76, p < 0.001, I = 36%). Subgroup analysis revealed a stronger association in Asian studies (HR: 1.74 for OS; 1.57 for PFS) compared to European studies (HR: 1.08 for OS; 1.05 for PFS). The prognostic impact remained significant regardless of anticancer treatment type, myosteatosis assessment method, sex-specific or universal cutoff values, and follow-up duration (p for subgroup differences all > 0.05). The results remained significant in studies adjusting for sarcopenia (HR: 1.89 for OS; 1.50 for PFS). Meta-regression analyses did not suggest any of the following variables may affect the results, including sample size, mean ages of the patients, proportions of men, follow-up durations, and study quality scores (p all > 0.05).Myosteatosis is independently associated with worse survival in HCC patients, particularly in Asian populations. These findings highlight the significance of assessing muscle quality as a prognostic factor in HCC.
以脂肪浸润骨骼肌为特征的肌脂肪变性越来越被认为是肝细胞癌（HCC）的一个预后因素，尽管结果并不一致。本荟萃分析旨在总结其对HCC患者总生存期（OS）和无进展生存期（PFS）的影响。对PubMed、Embase和Web of Science进行了系统检索，以确定报告有或无肌脂肪变性的HCC患者生存结果的观察性研究。使用随机效应模型计算合并风险比（HRs）及其95%置信区间（CIs）。共纳入24项涉及7436例HCC患者的回顾性队列研究。肌脂肪变性与较差的OS（HR：1.60，95%CI：1.40 - 1.83，p < 0.001，I = 65%）和PFS（HR：1.53，95%CI：1.33 - 1.76，p < 0.001，I = 36%）显著相关。亚组分析显示，与欧洲研究（OS的HR：1.08；PFS的HR：1.05）相比，亚洲研究中的相关性更强（OS的HR：1.74；PFS的HR：1.57）。无论抗癌治疗类型、肌脂肪变性评估方法、性别特异性或通用临界值以及随访时间如何，预后影响均显著（亚组差异的p均> 0.05）。在对肌肉减少症进行校正的研究中，结果仍然显著（OS的HR：1.89；PFS的HR：1.50）。荟萃回归分析未表明以下任何变量可能影响结果，包括样本量、患者平均年龄、男性比例、随访时间和研究质量评分（p均> 0.05）。肌脂肪变性与HCC患者较差的生存率独立相关，尤其是在亚洲人群中。这些发现突出了评估肌肉质量作为HCC预后因素的重要性。
