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Abstract：
BACKGROUND: Hepatocellular carcinoma (HCC) represents a major global health concern, characterized by evolving etiological patterns and a range of treatment options. Among various prognostic factors, sarcopenia, characterized by loss of skeletal muscle mass, strength, and function, has emerged as a pivotal contributor to HCC outcomes. Focusing on liver transplantation, surgical resection, locoregional treatments, and systemic therapies, this review aims to analyze the impact of sarcopenia on HCC treatment outcomes, shedding light on an underexplored subject in the pursuit of more personalized management.
METHODS: A comprehensive literature review was conducted by searching peer-reviewed articles on sarcopenia and treatment outcomes in patients with HCC from inception up to October 2023.
RESULTS: Sarcopenia was found to be prevalent among HCC patients, exhibiting different occurrence, possibly attributable to diverse diagnostic criteria. Notably, despite variations in studies utilizing skeletal muscle indices, sarcopenia independently correlated with lower overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) across surgical (both transplantation and resection), locoregional, and systemic therapies, including tyrosine-kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs). Moreover, a link between sarcopenia and increased rate and severity of adverse events, particularly in surgery and TKIs recipients, and larger tumor size at diagnosis was observed. While baseline sarcopenia negatively influenced treatment outcomes, alterations in muscle mass post-treatment emerged as primary determinants of reduced OS.
CONCLUSIONS: Sarcopenia, either present before or after HCC treatment, negatively correlates with response to it, across all etiologies and therapeutic strategies. Although only a few studies have evaluated the impact of supervised physical activity training on muscle mass and OS after HCC treatment, it is crucial to evaluate the presence of sarcopenia before treatment initiation, to better stratify patients\' prognosis, thus performing a more tailored approach, and identify therapies able to restore muscle mass in HCC patients. Conversely, the impact of sarcopenia on HCC recurrence and extrahepatic spread remains inadequately explored.
METHODS: A comprehensive literature review was conducted by searching peer-reviewed articles on sarcopenia and treatment outcomes in patients with HCC from inception up to October 2023.
RESULTS: Sarcopenia was found to be prevalent among HCC patients, exhibiting different occurrence, possibly attributable to diverse diagnostic criteria. Notably, despite variations in studies utilizing skeletal muscle indices, sarcopenia independently correlated with lower overall survival (OS), recurrence-free survival (RFS), and progression-free survival (PFS) across surgical (both transplantation and resection), locoregional, and systemic therapies, including tyrosine-kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs). Moreover, a link between sarcopenia and increased rate and severity of adverse events, particularly in surgery and TKIs recipients, and larger tumor size at diagnosis was observed. While baseline sarcopenia negatively influenced treatment outcomes, alterations in muscle mass post-treatment emerged as primary determinants of reduced OS.
CONCLUSIONS: Sarcopenia, either present before or after HCC treatment, negatively correlates with response to it, across all etiologies and therapeutic strategies. Although only a few studies have evaluated the impact of supervised physical activity training on muscle mass and OS after HCC treatment, it is crucial to evaluate the presence of sarcopenia before treatment initiation, to better stratify patients\' prognosis, thus performing a more tailored approach, and identify therapies able to restore muscle mass in HCC patients. Conversely, the impact of sarcopenia on HCC recurrence and extrahepatic spread remains inadequately explored.
摘要：
背景：肝细胞癌（HCC）是全球主要的健康问题，其特点是病因学模式和一系列治疗选择。在各种预后因素中，少肌症,以骨骼肌质量损失为特征，力量,和功能，已成为HCC结果的关键贡献者。专注于肝移植，手术切除,局部治疗，和全身疗法，这篇综述旨在分析肌少症对HCC治疗结果的影响，在追求更个性化的管理方面，揭示了一个未充分探索的主题。
方法：通过检索从开始到2023年10月关于肝癌患者的肌肉减少症和治疗结果的同行评审文章，进行了全面的文献综述。
结果：发现肌肉减少症在HCC患者中普遍存在，表现出不同的发生，可能归因于不同的诊断标准。值得注意的是,尽管利用骨骼肌指数的研究存在差异，肌肉减少症与较低的总生存期（OS）独立相关，无复发生存率（RFS），和无进展生存期（PFS）在整个手术（移植和切除），局部区域,和全身疗法，包括酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）。此外，肌肉减少症与不良事件发生率和严重程度之间的联系，特别是在手术和TKIs接受者中，并且在诊断时观察到较大的肿瘤大小。虽然基线肌肉减少对治疗结果有负面影响，治疗后肌肉质量的改变是OS降低的主要决定因素。
结论：肌肉减少症，无论是在肝癌治疗之前或之后，与对它的反应负相关，跨越所有病因和治疗策略。虽然只有少数研究评估了有监督的体育活动训练对肝癌治疗后肌肉质量和OS的影响，在治疗开始之前评估肌肉减少症的存在是至关重要的，为了更好地对患者的预后进行分层，因此采取了更有针对性的方法，并确定能够恢复HCC患者肌肉质量的治疗方法。相反，肌少症对HCC复发和肝外扩散的影响仍未充分探讨.
方法：通过检索从开始到2023年10月关于肝癌患者的肌肉减少症和治疗结果的同行评审文章，进行了全面的文献综述。
结果：发现肌肉减少症在HCC患者中普遍存在，表现出不同的发生，可能归因于不同的诊断标准。值得注意的是,尽管利用骨骼肌指数的研究存在差异，肌肉减少症与较低的总生存期（OS）独立相关，无复发生存率（RFS），和无进展生存期（PFS）在整个手术（移植和切除），局部区域,和全身疗法，包括酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）。此外，肌肉减少症与不良事件发生率和严重程度之间的联系，特别是在手术和TKIs接受者中，并且在诊断时观察到较大的肿瘤大小。虽然基线肌肉减少对治疗结果有负面影响，治疗后肌肉质量的改变是OS降低的主要决定因素。
结论：肌肉减少症，无论是在肝癌治疗之前或之后，与对它的反应负相关，跨越所有病因和治疗策略。虽然只有少数研究评估了有监督的体育活动训练对肝癌治疗后肌肉质量和OS的影响，在治疗开始之前评估肌肉减少症的存在是至关重要的，为了更好地对患者的预后进行分层，因此采取了更有针对性的方法，并确定能够恢复HCC患者肌肉质量的治疗方法。相反，肌少症对HCC复发和肝外扩散的影响仍未充分探讨.
