Table 3.
Liver resection for hepatocellular carcinoma (HCC).
| Reference (author, year) | Country | Study period | Type of study | Comparator | Parameter | Liver status | N° patients | Major resections (>3 segments), n (%) | Morbidity, n (%) | Liver surgery specific morbidity, n (%) | Liver Failure (ISGLS), n (%) | Major morbidity, n (%) | Mortality, n (%) | DFS/RFS (months), median (range) or (%) | OS (months), median (range) or (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Harimoto (2013) | Japan | 2004-2009 | Retrospective | Sarcopenia | SMM | Cirrhosis: S/NS: 43 (57)/56 (50.5); (ns) | 186. S/NS: 75/111 | NA | S/NS: 24 (32)/56 (50.5); (p=0.613) | NA | NA | NA | NA | 5-y RFS: S/NS: 13/33.2; (p=0.013) | 5-y S/NS: 71/83.7; (p=0.001) |
| Itoh (2014) | Japan | 2004-2009 | Retrospective | Visceral fat area at umbilicus | VFA | Cirrhosis: Low/High VFA: 33 (39.2)/27 (25.4); (p=0.041) | 190. Low/High VFA: 84/106 | NA | Low/High VFA: 17 (20.2)/19 (17.9); (p=0.686) | Low/High VFA: 6 (7)/6 (5.6); (p>0.05) | NA | NA | 0 (0) | 3-/5-/7-y High vs. Low VFA: 54.7/46.4/36.5 vs. 37.3/23.7/14.4; (p=0.001) | 3-/5-/7-y High vs. Low VFA: 86.5/78.2/74.3 vs. 79.0/65.3/45.2; (p=0.043) |
| Levolger (2015) | Netherlands | 2002-2013 | Retrospective | Sarcopenia | SMI | Cirrhosis: 45 (50.0). S/NS: 26 (50)/19 (50); (p=1.000) | 90 (resected: 71 (67.8)). SR/NSR: 36 (69.2)/25 (65.8) | NA | S/NS: 24 (46.2)/13 (34.2); (p=0.255) | NA | NA | S/NS: 17 (32.7)/5 (13.2); (p=0.033) | S/NS: 9 (17.3)/1 (2.6); (p=0.029) | S/NS: 18 (12–24)/18 (11–26); (p=0.67) | S/NS: 33 (17–48)/105 (28–181); (p=0.002) |
| Voron (2015) | France | 2006-2012 | Retrospective | Sarcopenia | SMI | Cirrhosis: 63 (57.8). S/NS: 32 (54.2)/31 (62); (p=0.41) | 109. S/NS: 59/50 | 68 (62.4). S/NS: 36 (62)/32 (64); (p=0.75) | 41 (37.6). S/NS: 23 (39)/18 (36); (ns) | NA | NA | 21 (19.3). S/NS: 13 (22.1)/8 (16); (p=0.560) | 5 (4.6). S/NS 4 (6.8)/1 (2) | S/NS: 10.1/34.23; (p<0.001) | S/NS: 52.3/ 70.3; 1-y: 69.8/95.5; (p=0.015) |
| Hamaguchi (2015) | Japan | 2005-2014 | Retrospective | Sarcopenia (skeletal muscle quality) | IMAC | Cirrhosis: 477 (100). High/normal IMAC: 209/268; (p=0.0679) | 477. High/normal IMAC: 209/268 | NA | NA | NA | NA | NA | NA | ↓RFS High/normal IMAC; (p=0.0012). Low/normal PMI: ns (p=0.7468) | ↓OS High/normal IMAC; (p< 0.0001). Low/normal PMI: ns (p=0.3178) |
| Harimoto (2016) | Japan | 2004-2013 | Retrospective | Sarcopenia | L3-SMA | Cirrhosis S/NS: 19/37; (ns) | 296. S/NS: 57/82 | NA | S/NS: 7 (12.2)/15 (18.3); (p=0.4791) | NA | NA | NA | NA | DFS in patients with sarcopenia also significantly associated with poor prognosis in the older patient group (P=0.030). |
↓OS in sarcopenic patients aged ≥70 years (P=0.002). |
| Kamachi (2016) | Japan | 2005-2013 | Retrospective | Sarcopenia | SMI | Cirrhosis: 92 (100) (Child A) | 92. S/NS: 61/31. Resection: 35 (57)/11 (35); (p=0.05) | NA | NA | NA | NA | NA | NA | 1-/3-/5-y RFS S/NS: 39.1/77.1/81.7 vs. 23.5/59.5/75.7; (p=0.03). | 1-/3-/5-y S/NS: 91.3/73.6/ 50.5 vs. 96.4/91.6/68.7; (p=0.04) |
| Takagi (2016) | Japan | 2007 - 2013 | Retrospective | Sarcopenia, ASA score | SMI | Healthy | 254. S/NS: 118/136 | 97. S/NS: 48/49; (p=0.31) | NA | NA | NA | 35. S/NS: 16/19; (p=0.32) | 5. S/NS: 1/4; (p=0.13) | NA | S/NS: 58.2/82.4; (p=0.0002). Risk 0 group (NS, ASA<3): 85.6. Risk 1 group (S or ASA>3): 62.4. Risk 2 group (S AND ASA>3): 22.8 |
| Hamaguchi (2016) | Japan | 2005 - 2014 | Retrospective | Quality and quantity of skeletal muscle |
IMAC, PMI | Child A/B: 449 (91)/43 (9) | 492. High/normal-IMAC: 219/273 | 172 (35). High/normal-IMAC: 80 (37)/92 (34); (p=0.513) | 180 (37) | 82 (16.6) | 10 (2.0) | 108 (22). High/normal-IMAC: 60 (27)/48 (18); (p=0.009). Low/normal PMI: 36 (36)/72 (20); (p=0.229) | 12 (2.4) | NA | NA |
| Yabusaki (2016) | Japan | 2003-2014 | Retrospective | Sarcopenia | SMI, VFA | Cirrhosis 195 (100); Child A/B: 182 (93)/13 (7) | 195. Low/high-SMI: 89/106 | 62 (31.8). Low/High-SMI: 25(28)/37(35); (p=0.31) | 41 (21.0). Low/High-SMI: 18 (20.2)/23 (21.7); (p=0.80) | NA | NA | NA | 5 (2.6). Low/High-SMI: 2 (2.2)/3 (2.8); (p=0.8) | NA | NA |
| Kobayashi (2016) | Japan | 2007-2012 | Retrospective | The quality and quantity of skeletal muscle | ΔIMAC, ΔPMI | NA | 241. Preoperative normal IMAC: 112 (High/Low ΔIMAC 6 M: 32/43. High/Low ΔPMI 6 M: 24/51) | 81 (33.6) | NA | NA | NA | NA | NA | Preoperative normal IMAC: High/Low ΔIMAC 6 M: 19.5/30.3; (p=0.021). High/Low ΔPMI 6 M: 17.9/32.6; (p=0.088). High ΔIMAC (but not High ΔPMI) 6 M (p=0.024) risk factor for HCC recurrence. | NA |
| Kobayashi (2017) | Japan | 2005-2015 | Retrospective | Sarcopenia, obesity, sarcopenic obesity | SMI, BMI | Cirrhosis: 239 (51.4). NN/NO/SN/SO: 99 (53.8)/115 (52.5)/15 (48.4)/10 (32.3) | 465. NN/NO/SN/SO: 184 (39.5)/219 (47.1)/31 (6.7)/31 (6.7) | 175 (37.6). NN/NO/SN/SO: 69 (37.5)/78 (35.6)/12 (38.7)/16 (51.6); (p=0.395) | 163 (35.1). NN/NO/SN/SO: 57 (31)/78 (35.6)/15 (48.4)/13 (41.9); (p=0.218) | NA | NA | 97 (20.9). NN/NO/SN/SO: 31 (16.9)/44 (20.1)/12 (38.7)/10 (32.3); (p=0.093) | NA | 1-/3-y RFS NN/NO/SN/SO: 64.4/37.8 vs. 64.9/38.1 vs. 52.7/31.5 vs.33.8/19.3. ↓SO/NN (p=0.003). | 1-, 3-, 5-y: NN/NO/SN/SO 91.1, 78.2, 61.0/91.2, 72.6, 58.2/77.4, 62.7, 38.8/83.9, 45.6, 45.6. ↓SO vs. NN (p=0.002). |
| Kroh (2018) | German/Netherlands | 2010-2014 | Retrospective | Sarcopenia, obesity, sarcopenic obesity | L3 MI, BFA | Cirrhosis: 43 (61). S/NS: 18 (55)/25 (68); (p=0.3282). O/NO: 15 (54)/28 (67); (p=0.3211). SO/NSO: 10 (48)/33 (67); (p=0.1800) | 70. S/NS: 33/37. O/NO: 28/42. SO/NSO: 21/49 | NA | 18 (26). S/NS: 8 (24)/10 (27); (p=1.0). O/NO: 7 (25)/11 (26); (p=1.0). SO/NSO: 6 (29)/12 (25); (p=0.7693) | 21 (30). S/NS: 7 (21)/14 (38); (p=0.1916). O/NO: 7 (25)/14 (33); (p=0.5961); SO/NSO: 5 (24)/16 (33); (p=0.5745) | 4 (6). S/NS: 3 (9)/1 (3); (p=0.3368). O/NO: 2 (7)/2 (5); (p=1.0). SO/NSO: 2 (10)/2 (4) SO; (p=0.5780) | 8 (11). S/NS: 4 (12)/4 (11); (p=1.0). O/NO: 3 (11)/5 (12); (p=1.0); SO/NSO: 3 (14)/5 (10); (p=0.6889) | 4 (6). S/NS: 1 (3)/3 (8); (p=0.6165). O/NO: 1 (4)/3 (7); (p=0.6450); SO/NSO: 1 (5)/3 (6); (p=1.0) | NA | S/NS/O/NO/SO/NSO: 2.54 (-)/1.44 (1.05-2.07)/2.07 (-)/1.51 (0.93-2.51)/2.63 (-)/1.51 (1.05-2.07). 1-year: 72.7 (59.0-89.6)/67.6 (54.0-84.5)/82.1 (69.1-97.6)/61.9 (48.8-78.5)/81.0 (65.8-99.6)/65.3 (53.3-80.1). 3-y: 45.0 (29.5–68.6)/13.6 (5.6-32.9)/38.5 (22.6-65.5)/20.4 (10.6-39.2)/48.6 (29.0-81.4)/19.5 (10.5-36.0) |
| Miyachi (2019) | Japan | 2005-2015 | Retrospective | Bone Mineral Density | BMD at Th11 | Low/normal BMD: 145 (70)/127 (79); (p=0.072) | 465. Low/normal BMD: 206/161 | NA | NA | NA | NA | 85(18). Low/normal BMD: 47 (23)/26 (16); (p=0.116) | low BMD associated with a 1.7-fold higher hazard of mortality in males | low BMD not associated with worse RFS in total (p=0.523), male (p=0.809) and female patients (p=0.402). |
low BMD associated with worse cancer-specific survival in male patients (p=0.015) |
| Okubo (2021) | Japan | 2011-2017 | Retrospective | Visceral adiposity | VSR | Fibrosis(F3) or cirrhosis (F4): 100% | 181. High/low VSR: 60/121 | 11 (6) | 34 (19): High/Low VSR: 16(27)/18(15); (p=0.046) | NA | NA | 8 (4). High/Low VSR: 5(7)/3(2); (p=0.071) | NA | NA | NA |
| Yang (2021) | South Korea | 2002-2011 | Retrospective | Sarcopenia, myosteatosis (IMF), visceral adiposity | PMI, PMA, VATI | Cirrhosis: 86 (53.8). S/NS: 16 (57.1)/70 (53.0); (p=0.692) | 160. S/NS: 28 (17.5)/132 (82.5) | NA | NA | NA | NA | NA | 72 (45) | 3.2 (0.1-15.2). S/NS: ns; (p=0.103). Recurrence S/NS: 16 (57.1)/73 (55.3); (p=0.217) | 7.9 (0.1-15.2). S/NS: (p=0.001). Death S/NS: 20 (71.4)/52 (39.4); (p=0.003) |
| Meister (2022) | Germany | 2008-2019 | Retrospective | Sarcopenia, Myosteatosis | SMI, SM-RA | Cirrhosis: 42 (42) | 100. MYS/NMYS: 60/40; S/NS: 54/46 | 25 (25) | NA | NA | NA | 17 (17). S/NS: 8(15)/9(20). MYS/NMYS: 15(25)/2(5) | 6 (6) | DFS S/NS: 35/40; 1-y: 71/89. 3-y: 47/63. 5-y: 27/49; (p=0.118) | MYS/NMYS: 41/60. 1-y: 87/100. 3-y: 57/66. 5-y: 39/48; (p=0.223) |
HCC, hepatocellular carcinoma; S, sarcopenia; NS, non-sarcopenia; SMM, skeletal muscle mass; SMI, skeletal muscle index; PMI, psoas muscle index; MA, muscle attenuation; VSR, visceral to subcutaneous adipose tissue area ratio; SR-MA, muscle attenuation; IMAC, intramuscular adipose content; BTC, biliary tract cancers; NSR, non-sarcopenic resectable; SR, sarcopenic resectable; NA, not assessed.