Abstract：
BACKGROUND: The specific CT-related skeletal muscle parameters predictive of postoperative survival in liver transplant (LT) patients with hepatocellular carcinoma (HCC) remain unclear. There is increasing evidence supporting the role of fatty acids and their lipid intermediates in regulating skeletal muscle mass and function, the relationship between lipoprotein subfractions and body composition remains unclear.
METHODS: Adult patients with HCC who underwent LT between January 2015 and September 2022 were retrospectively analyzed. CT parameters, including skeletal muscle index (SMI), psoas muscle index (PMI), skeletal muscle density (SMD), visceral and subcutaneous adipose tissue (VAT and SAT), and the VAT/SAT ratio at the L3 level, and lipid profiles, were assessed prior to LT.
RESULTS: Of the 284 LT patients with HCC, 224 underwent CT (L3 level) within 3 months of LT, and 82 (37%) were diagnosed with myosteatosis. Patients with myosteatosis exhibited significantly lower 1- and 3-year survival rates (p = 0.002, p = 0.01), a trend persisting even beyond the Milan criteria (p = 0.004, p = 0.04). After adjusting for covariates, SMD demonstrated a significant negative correlation with post-transplant survival (HR: 0.90, [95% Confidence Interval(CI): 0.83-0.98], C-statistic: 0.78, p = 0.009). Pearson\'s correlation analysis revealed a positive correlation between high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(ApoA1) levels and SMD. Multivariate stepwise regression analysis demonstrated that every 10 Hounsfield unit decrease in SMD was associated with a 0.16 mmol/L decrease in HDL-C and a 0.18 g/L decrease in ApoA1.
CONCLUSIONS: Routine abdominal CT scans for assessing skeletal muscle density before LT were significantly associated with post-transplant mortality. Furthermore, abnormal HDL-C and ApoA1 levels before LT were associated with myosteatosis.
METHODS: Adult patients with HCC who underwent LT between January 2015 and September 2022 were retrospectively analyzed. CT parameters, including skeletal muscle index (SMI), psoas muscle index (PMI), skeletal muscle density (SMD), visceral and subcutaneous adipose tissue (VAT and SAT), and the VAT/SAT ratio at the L3 level, and lipid profiles, were assessed prior to LT.
RESULTS: Of the 284 LT patients with HCC, 224 underwent CT (L3 level) within 3 months of LT, and 82 (37%) were diagnosed with myosteatosis. Patients with myosteatosis exhibited significantly lower 1- and 3-year survival rates (p = 0.002, p = 0.01), a trend persisting even beyond the Milan criteria (p = 0.004, p = 0.04). After adjusting for covariates, SMD demonstrated a significant negative correlation with post-transplant survival (HR: 0.90, [95% Confidence Interval(CI): 0.83-0.98], C-statistic: 0.78, p = 0.009). Pearson\'s correlation analysis revealed a positive correlation between high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1(ApoA1) levels and SMD. Multivariate stepwise regression analysis demonstrated that every 10 Hounsfield unit decrease in SMD was associated with a 0.16 mmol/L decrease in HDL-C and a 0.18 g/L decrease in ApoA1.
CONCLUSIONS: Routine abdominal CT scans for assessing skeletal muscle density before LT were significantly associated with post-transplant mortality. Furthermore, abnormal HDL-C and ApoA1 levels before LT were associated with myosteatosis.
摘要：
背景：预测肝细胞癌（HCC）肝移植（LT）患者术后生存的特定CT相关骨骼肌参数仍不清楚。越来越多的证据支持脂肪酸及其脂质中间体在调节骨骼肌质量和功能中的作用。脂蛋白亚组分与身体成分之间的关系仍不清楚。
方法：回顾性分析2015年1月至2022年9月接受LT的成人HCC患者。CT参数,包括骨骼肌指数（SMI），腰大肌指数（PMI），骨骼肌密度（SMD），内脏和皮下脂肪组织（增值税和SAT），以及L3级别的增值税/SAT比率，和脂质分布，在LT之前进行了评估。
结果：在284例LT肝癌患者中，224例LT后3个月内接受了CT（L3级），和82（37％）被诊断为肌肉骨化。肌骨形成患者1年和3年生存率显著降低(p=0.002,p=0.01),这一趋势甚至持续超过米兰标准(p=0.004，p=0.04)。在调整协变量后，SMD与移植后存活率呈显著负相关(HR:0.90,[95%置信区间(CI):0.83-0.98],C统计量：0.78，p=0.009）。Pearson相关分析显示高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(ApoA1)水平与SMD呈正相关。多变量逐步回归分析表明，SMD每减少10Hounsfield单位，HDL-C减少0.16mmol/L，ApoA1减少0.18g/L。
结论：肝移植前常规腹部CT扫描评估骨骼肌密度与移植后死亡率显著相关。此外，LT术前HDL-C和ApoA1水平异常与肌萎缩相关.
方法：回顾性分析2015年1月至2022年9月接受LT的成人HCC患者。CT参数,包括骨骼肌指数（SMI），腰大肌指数（PMI），骨骼肌密度（SMD），内脏和皮下脂肪组织（增值税和SAT），以及L3级别的增值税/SAT比率，和脂质分布，在LT之前进行了评估。
结果：在284例LT肝癌患者中，224例LT后3个月内接受了CT（L3级），和82（37％）被诊断为肌肉骨化。肌骨形成患者1年和3年生存率显著降低(p=0.002,p=0.01),这一趋势甚至持续超过米兰标准(p=0.004，p=0.04)。在调整协变量后，SMD与移植后存活率呈显著负相关(HR:0.90,[95%置信区间(CI):0.83-0.98],C统计量：0.78，p=0.009）。Pearson相关分析显示高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(ApoA1)水平与SMD呈正相关。多变量逐步回归分析表明，SMD每减少10Hounsfield单位，HDL-C减少0.16mmol/L，ApoA1减少0.18g/L。
结论：肝移植前常规腹部CT扫描评估骨骼肌密度与移植后死亡率显著相关。此外，LT术前HDL-C和ApoA1水平异常与肌萎缩相关.
