Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions

Table 1 Outcomes of hepatocellular carcinoma patients undergoing loco-regional therapy with sarcopenia

Ref.	Technique	n	Methods and outcomes
RFA
Iritani et al[15] (2012-2014, Japan)	RFA	217	L3-SMI. B36.0 cm2/m2 for men and B29.0 cm2/m2 for women. Sarcopenia patients had lower OS than those without
Fujiwara et al[57] (2015, Japan)	RFA	515	L3-SMI used. B36.2 cm2/m2 for men and B29.6 cm2/m2 for women. Sarcopenia was associated with a higher risk of recurrence in very early/early-stage HCC who underwent treatment with RFA.
Yuri et al[58] (2017, Japan)	RFA	182	PMI used. 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Sarcopenia was associated with overall reduced HCC survival with no effect on recurrence.
TACE
Dodson et al[38] (2013, United States)	TACE drug eluding TACE	216	TPA was used to assess sarcopenia. TPA of < 477 mm/m2 for men and < 338 mm/m2 for woman. Sarcopenia was independently associated with increased risk of death (lowest vs highest TPA quartile, HR = 1.84; P = 0.04)
Kobayashi et al[60] (2018, Japan)	TACE	102	L3-SMI used. 42 cm2/m2 for men and 38 cm2/m2 for women. Change in L3-SMI was an independent prognostic factor in patients with HCC treated with TACE.
Loosen et al[61] (2019, Germany)	TACE	56	Mean PMI was 11.81 mm/m2. Low PMI (13.39 mm/m2) had significantly lower median overall survival (491 d) compared to high PMI (1291 d)
Fujita et al[59] (2019, Japan)	TACE	179	PMI used. < 6.0 cm2/m2 for men and < 3.4 cm2/m2 for women. No difference was normal with low PMI and normal PMI for HCC outcomes. However, changes in PMI were significant after TACE with significant loss of liver function reserves post treatment.
TARE
Faron et al[32] (2020, Europe)	TARE	58	MRI derived FFMA were used to predict sarcopenia. FFMA < 3582 mm2 for men and < 2301 mm2 for men. Low FFMA was associated with significantly reduced OS (197 vs 294, P = 0.02).

Studies depicting various loco-regional treatments utilized in hepatocellular carcinoma in relation to sarcopenia. RFA: Radiofrequency Ablation; TACE: Transarterial chemoembolization; TARE: Transarterial radiofrequency embolization; L3-SMI: Third lumbar vertebrae-skeletal muscle index; OS: Overall survival; HCC: Hepatocellular carcinoma; TPA: Total psoas area; FFMA: Fat-free muscle area; PMI: Psoas muscle index.