Sarcopenia with systemic inflammation can predict survival in patients with hepatocellular carcinoma undergoing curative resection

Background: This study aimed to examine the prognostic significance of sarcopenia combined with systemic inflammation in patients who underwent curative hepatectomy for hepatocellular carcinoma (HCC). Methods: Between January 2010 and July 2019, we identified 159 patients with HCC who underwent curative hepatectomy at three institutional centers. We retrospectively analyzed clinicopathological outcomes, surgical outcomes, platelet lymphocyte ratio (PLR) as a systemic inflammatory marker, and computed tomography (CT)-assessed sarcopenia at the third lumbar vertebra level (L3). Results: Sarcopenia was noted in 74 (46.5%) of 159 patients and was significantly associated with male sex, low body mass index (BMI), and high PLR. In the multivariate analysis, sarcopenia [hazard ratio (HR): 2.127, P=0.026] and high PLR (HR: 1.971, P=0.038) were associated with a decrease in overall survival (OS) but not in recurrence-free survival (RFS). The combination of sarcopenia and PLR status stratified the 5-year OS into 82.0% (non-sarcopenia and a low PLR), 68.3% (sarcopenia or a high PLR), and 44.4% (sarcopenia and a high PLR) (P=0.001). In the multivariate analysis, sarcopenia and a high PLR and sarcopenia or a high PLR were revealed to be significant predictors of OS (HR: 4.300, P=0.001 and HR: 2.723, P=0.010, respectively). Conclusions: Sarcopenia and high PLR were significantly associated with poor OS. The combination of these two factors may be useful for predicting survival of patients with HCC undergoing curative hepatectomy.

Automated summary

This study reveals the prognostic significance of sarcopenia combined with systemic inflammation in patients with hepatocellular carcinoma (HCC) undergoing curative hepatectomy. It shows that sarcopenia and high platelet lymphocyte ratio (PLR) are significantly associated with poor overall survival (OS), and the combination of sarcopenia and high PLR status can be useful in predicting survival in these patients.