Background: Osteopenia is a well-known risk factor for survival in patients with hepatocellular carcinoma; however, it is unclear whether osteopenia can apply to both genders and how osteopenia is associated with cancer progression. The aim of this study was to elucidate whether osteopenia predicts reduced survival in regression models in both genders and whether osteopenia is associated with the pathological factors associated with reduced survival. Methods: This study included 188 consecutive patients who underwent hepatectomy. Bone mineral density was assessed using computed tomography (CT) scan images taken within 3 months before surgery. Non-contrast CT scan images at the level of the 11th thoracic vertebra were used. The cutoff value of osteopenia was calculated using a threshold value of 160 Hounsfield units. Overall survival (OS) curves and recurrence-free survival (RFS) were constructed using the Kaplan–Meier method, as was a log-rank test for survival. The hazard ratio and 95% confidence interval for overall survival were calculated using Cox’s proportional hazard model. Results: In the regression analysis, age predicted bone mineral density. The association in females was greater than that in males. The OS and RFS of osteopenia patients were shorter than those for non-osteopenia patients. According to univariate and multivariate analyses, osteopenia was an independent risk factor for OS and RFS. The sole pathological factor associated with osteopenia was microvascular portal vein invasion. Conclusion: Models suggest that osteopenia may predict decreased OS and RFS in patients undergoing resection of hepatocellular carcinoma due to the mechanisms mediated via microvascular portal vein invasion.
背景：骨质减少是肝细胞癌患者生存率的已知风险因素，但其是否适用于两性以及如何与癌症进展相关尚不明确。本研究旨在阐明在回归模型中骨质减少是否可预测两性生存率降低，以及骨质减少是否与导致生存率降低的病理因素相关。方法：本研究纳入188例连续接受肝切除术的患者。骨密度通过术前3个月内进行的计算机断层扫描（CT）图像进行评估，采用第11胸椎水平的非增强CT扫描图像，以160亨氏单位作为骨质减少的临界值。使用Kaplan-Meier法绘制总生存期（OS）和无复发生存期（RFS）曲线，并采用对数秩检验进行生存分析。通过Cox比例风险模型计算总生存期的风险比及95%置信区间。结果：回归分析显示年龄可预测骨密度，且女性关联性高于男性。骨质减少患者的OS和RFS均短于非骨质减少患者。单变量和多变量分析表明，骨质减少是OS和RFS的独立风险因素。唯一与骨质减少相关的病理因素是微血管门静脉侵犯。结论：模型提示，骨质减少可能通过微血管门静脉侵犯介导的机制，预测接受肝细胞癌切除术患者OS和RFS的降低。
肿瘤(癌症)患者之家