Background and Aim: Transcatheter liver-directed intra-arterial therapies are mainstream treatment options for intermediate-stage hepatocellular carcinoma (HCC). However, the effect of low skeletal muscle mass (LSMM) on overall survival (OS) in these patients remains uncertain. We aimed to ascertain the prevalence and prognostic effect of LSMM in this population. Method: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was performed in the PubMed and Embase databases until Oct 2023. Random-effects meta-analysis was performed to determine the pooled prevalence of LSMM and calculate the hazard ratio (HR) for OS with a 95% confidence interval (CI) in patients with intermediate-stage HCC undergoing various transarterial therapies, comparing those with and without LSMM. Results: Twelve studies involving 2450 patients were included. The pooled prevalence of LSMM was 46% (95% CI, 38–55%), and the results were consistent across different treatments, regions, and age subgroups. The meta-analysis indicated that LSMM was significantly associated with decreased OS (HR, 1.78; 95% CI, 1.36–2.33;I2, 75%). Subgroup analyses reassured the main findings across various therapies, including transarterial chemoembolization (TACE) (HR, 1.68; 95% CI, 1.23–2.30;I2, 81%), transarterial embolization (TAE) (HR, 2.45; 95% CI, 1.42–4.22;I2, 0%), and transarterial radioembolization (TARE) (HR, 1.94; 95% CI, 1.01–3.73;I2, 0%). Conclusions: In intermediate-stage HCC, LSMM is common and associated with reduced OS. To achieve an optimal prognosis, clinicians should incorporate routine LSMM measurement into practice, while caring for patients with intermediate-stage HCC, irrespective of TACE, TAE, and TARE.
背景与目的：经导管肝动脉导向介入治疗是中晚期肝细胞癌的主流治疗方案，但低骨骼肌质量对该类患者总生存期的影响尚不明确。本研究旨在评估该人群中低骨骼肌质量的患病率及其预后影响。方法：遵循系统综述与荟萃分析优先报告规范，对截至2023年10月的PubMed和Embase数据库进行全面检索。采用随机效应模型进行荟萃分析，计算接受不同动脉介入治疗的中晚期肝细胞癌患者中低骨骼肌质量的汇总患病率，并通过比较有无低骨骼肌质量患者的风险比及其95%置信区间评估对总生存期的影响。结果：共纳入12项研究，涉及2450例患者。低骨骼肌质量汇总患病率为46%（95%置信区间：38%-55%），该结果在不同治疗方案、地域和年龄亚组中保持一致。荟萃分析显示低骨骼肌质量与总生存期降低显著相关（风险比：1.78；95%置信区间：1.36-2.33；异质性指数I²=75%）。亚组分析进一步验证了该结论在不同治疗方式中的一致性，包括经动脉化疗栓塞（风险比：1.68；95%置信区间：1.23-2.30；I²=81%）、经动脉栓塞（风险比：2.45；95%置信区间：1.42-4.22；I²=0%）和经动脉放射栓塞（风险比：1.94；95%置信区间：1.01-3.73；I²=0%）。结论：在中晚期肝细胞癌患者中，低骨骼肌质量普遍存在且与总生存期缩短相关。为获得最佳预后，临床医师在实施经动脉化疗栓塞、经动脉栓塞或经动脉放射栓塞治疗时，应将常规低骨骼肌质量评估纳入中晚期肝细胞癌患者的临床管理实践。
肿瘤(癌症)患者之家