Background and aims: Sarcopenia has been associated with poor outcomes in patients with cirrhosis and hepatocellular carcinoma. We investigated the impact of sarcopenia on survival in patients with advanced hepatocellular carcinoma treated with Sorafenib. Methods: A total of 328 patients were retrospectively analyzed. All patients had an abdominal CT scan within 8 weeks prior to the start of treatment. Two cohorts of patients were analyzed: the “Training Group” (215 patients) and the “Validation Group” (113 patients). Sarcopenia was defined by reduced skeletal muscle index, calculated from an L3 section CT image. Results: Sarcopenia was present in 48% of the training group and 50% of the validation group. At multivariate analysis, sarcopenia (HR: 1.47,p= 0.026 in training; HR 1.99,p= 0.033 in validation) and MELD > 9 (HR: 1.37,p= 0.037 in training; HR 1.78,p= 0.035 in validation) emerged as independent prognostic factors in both groups. We assembled a prognostic indicator named “SARCO-MELD” based on the two independent prognostic factors, creating three groups: group 1 (0 prognostic factors), group 2 (1 factor) and group 3 (2 factors), the latter with significantly worse survival and shorter time receiving treatment.
背景与目的：肌肉减少症与肝硬化及肝细胞癌患者的不良预后相关。本研究旨在探讨肌肉减少症对接受索拉非尼治疗的晚期肝细胞癌患者生存期的影响。方法：回顾性分析328例患者资料。所有患者在治疗开始前8周内均接受腹部CT扫描。研究分为两个队列："训练组"（215例）和"验证组"（113例）。肌肉减少症通过L3层面CT图像计算的骨骼肌指数降低来定义。结果：训练组48%和验证组50%的患者存在肌肉减少症。多变量分析显示，肌肉减少症（训练组HR：1.47，p=0.026；验证组HR：1.99，p=0.033）及MELD评分>9（训练组HR：1.37，p=0.037；验证组HR：1.78，p=0.035）在两组中均为独立预后因素。基于这两个独立预后因素，我们构建了名为"SARCO-MELD"的预后指标，将患者分为三组：第1组（0个预后因素）、第2组（1个因素）和第3组（2个因素），其中第3组患者生存期显著缩短，接受治疗的时间也明显减少。
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