search for

Ann Clin Nutr Metab 2023;15(3):65-66
Published online December 1, 2023
Association between sarcopenia and prognosis of hepatocellular carcinoma
Hae Il Jung

Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
Correspondence to: Hae Il Jung, email:
Received October 18, 2023; Revised October 18, 2023; Accepted October 18, 2023.
© 2023 The Korean Society of Surgical Metabolism and Nutrition and The Korean Society for Parenteral and Enteral Nutrition.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and ranks as the fourth leading cause of cancer-related death. Research has shown a strong association between HCC and chronic liver disease, especially in patients with cirrhosis. Individuals with these coexisting conditions often experience reduced appetite, compromised nutrient absorption, and anorexia, leading to disruptions in both nutritional status and skeletal muscle health [1]. While there are established methods for predicting patient prognosis based on tumor staging, such as Barcelona Clinic Liver Cancer staging classification and tumor-node-metastasis classification, these approaches do not evaluate nutritional well-being and skeletal muscle condition. Moreover, although Child–Pugh score takes into account indicators like albumin and ascites, which offer some insight into nutritional status, it is limited by inherent subjectivity [2]. Sarcopenia is a skeletal muscle disorder characterized by the gradual loss of skeletal muscle mass and strength. Research has shown that this reduction in muscle mass is associated with weakened immunity, lower quality of life, and elevated risk of fractures and falls, all of which ultimately lead to unfavorable clinical outcomes [3]. In recent years, an increasing body of literature has highlighted the connection between declining skeletal muscle mass and poor prognoses in cancer patients, including those with HCC. However, there has been no comprehensive prospective study thoroughly investigating the relationship between sarcopenia and HCC. A recent meta-analysis revealed that sarcopenia negatively impacts clinical outcomes for individuals with cirrhosis. However, while the study did include a certain number of HCC patients, it did not provide a definitive understanding of the association between sarcopenia and HCC [4]. Recently, several studies have demonstrated that sarcopenia is associated with reduced survival in patients with advanced HCC undergoing sorafenib treatment [3,5-7]. In an issue of the Annals of Clinical Nutrition and Metabolism, Lee and Park [5] examined the clinical significance of sarcopenia in patients with advanced HCC undergoing sorafenib treatment. The authors aimed to determine the prognostic value of sarcopenia in patients treated with sorafenib for advanced HCC. Their findings revealed that sarcopenia was independently associated with reduced overall survival. However, it is important to interpret these results with caution due to the study’s limitations, including its retrospective design, small sample size, and short follow-up period. Additionally, the study did not provide information regarding the association between the use of sorafenib and its adverse events. Despite these limitations, the study identified sarcopenia as an independent factor associated with reduced overall survival in HCC patients receiving sorafenib therapy. Further large-scale studies are warranted to validate these findings and establish the broader applicability of sarcopenia as a prognostic marker.

  1. Jiang C, Wang Y, Fu W, Zhang G, Feng X, Wang X, et al. Association between sarcopenia and prognosis of hepatocellular carcinoma: a systematic review and meta-analysis. Front Nutr 2022;9:978110.
    Pubmed KoreaMed CrossRef
  2. Guo Y, Ren Y, Zhu L, Yang L, Zheng C. Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: an updated meta-analysis. Sci Rep 2023;13:934.
    Pubmed KoreaMed CrossRef
  3. Cheng TY, Lee PC, Chen YT, Chao Y, Hou MC, Huang YH. Pre-sarcopenia determines post-progression outcomes in advanced hepatocellular carcinoma after sorafenib failure. Sci Rep 2020;10:18375.
    Pubmed KoreaMed CrossRef
  4. Liu J, Luo H, Huang L, Wang J. Prevalence of sarcopenia among patients with hepatocellular carcinoma: a systematic review and meta-analysis. Oncol Lett 2023;26:283.
    Pubmed KoreaMed CrossRef
  5. Lee MH, Park MS. Clinical significance of sarcopenia in patients with advanced hepatocellular carcinoma undergoing sorafenib treatment. Ann Clin Nutr Metab 2021;13:62-7.
  6. Nishikawa H, Nishijima N, Enomoto H, Sakamoto A, Nasu A, Komekado H, et al. Prognostic significance of sarcopenia in patients with hepatocellular carcinoma undergoing sorafenib therapy. Oncol Lett 2017;14:1637-47.
    Pubmed KoreaMed CrossRef
  7. Takada H, Kurosaki M, Nakanishi H, Takahashi Y, Itakura J, Tsuchiya K, et al. Impact of pre-sarcopenia in sorafenib treatment for advanced hepatocellular carcinoma. PLoS One 2018;13:e0198812.
    Pubmed KoreaMed CrossRef

December 2023, 15 (3)
Full Text(PDF) Free

Social Network Service

Cited By Articles
  • CrossRef (0)
  • View (183)
  • Download (137)