Preoperative computed tomography-assessed skeletal muscle index is a novel prognostic factor in patients with hepatocellular carcinoma following hepatectomy: a meta-analysis

Liqian Xu; Yuxia Jing; Chen Zhao; Qin Zhang; Xiaohong Zhao; Ji Yang; Lizhen Wu; Yunmei Yang

doi:10.21037/jgo-20-122

Preoperative computed tomography-assessed skeletal muscle index is a novel prognostic factor in patients with hepatocellular carcinoma following hepatectomy: a meta-analysis

J Gastrointest Oncol. 2020 Oct;11(5):1040-1053. doi: 10.21037/jgo-20-122.

Authors

Liqian Xu^{1

2}, Yuxia Jing³, Chen Zhao⁴, Qin Zhang^{1

2}, Xiaohong Zhao^{1

2}, Ji Yang^{1

2}, Lizhen Wu^{1

2}, Yunmei Yang^{1

2}

Affiliations

¹ Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
² Department of Geriatrics, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
³ Department of Geriatrics, Tianjin Fifth Central Hospital, Tianjin, China.
⁴ Institute of Physical Education, Huzhou University, Huzhou, China.

Abstract

Background: Recently, several studies have examined the association between preoperative sarcopenia and prognosis evaluation in patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. However, their conclusions remain ambiguous and controversial. Thus, we conducted a meta-analysis to assess the prognostic role of preoperative sarcopenia in patients with HCC undergoing hepatectomy.

Methods: We searched the existing literature reporting on the prognostic value of preoperative computed tomography (CT)-assessed sarcopenia for the survival of patients with HCC undergoing hepatectomy. The pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of overall survival (OS) and disease-free survival (DFS) were used to assess the prognostic value of preoperative sarcopenia in HCC patients. The associations between preoperative sarcopenia and clinicopathological characteristics were also evaluated.

Results: A total of six studies with 1,420 patients (including 458 sarcopenia and 962 non-sarcopenia patients) were included in the meta-analysis. The results showed that preoperative sarcopenia was significantly associated with poor OS (HR =1.572, 95% CI: 1.342-1.840, P=0) and shorter DFS (HR =1.544, 95% CI: 1.178-2.024, P=0.002) in patients with HCC undergoing hepatectomy. Preoperative sarcopenia was also significantly related to larger diameter tumors (WMD =0.598, 95% CI: 0.216-0.980, P=0.002). The results of the sensitivity analysis were stable in this meta-analysis. Egger's tests revealed that there was no significant publication bias.

Conclusions: Sarcopenia appears to have significant adverse impacts on postoperative outcomes in patients with hepatocellular carcinoma following hepatectomy. However, further large-scale prospective studies are needed to confirm our findings.

Keywords: Preoperative sarcopenia; disease-free survival (DFS); hepatocellular carcinoma (HCC); overall survival (OS); skeletal muscle mass index (SMI).