Sarcopenia in hepatocellular carcinoma: Current knowledge and future directions

Table 3 Outcomes of hepatocellular carcinoma patients undergoing liver transplant with sarcopenia over last 5 years

Ref.	Technique	n	Methods and outcomes
Itoh et al[114] (2016, Japan)	Living-donor LT	153	Based on SVR, patients with low SVR were had poor prognosis than without low SVR for OS (P = 0.03) and recurrence-free survival (P = 0.01).
Carey et al[68] (2016, United States)	Awaiting LT	396	L3-SMI used. 50 cm2/m2 for men and 39 cm2/m2 for women. Patients who died had lower SMI compared to those who survived (45.6 cm2/m2 vs 48.5 cm2/m2; P < 0.001), and SMI was associated with wait-list mortality (HR, 0.95; P < 0.001)[72].
Wada et al[67] (2017, Japan)	LDLT	32	TPA was used. TPA of 791.6 mm2/m2 for men and 488.8 mm2/m2 for women. TPV was used to compare to TPA. Preoperative TPV is a better predictor compared to TPA in assessing post-operative risks in LDLT recipients[71].
Golse et al[70] (2017, Europe)	LT	256	PMA, L3-SMI was used. 1561 mm2 for men and 1464 mm2 for women. One and 5-yr OS rates were significantly poorer in the sarcopenic group than in the nonsarcopenic group at 59% vs 94% and 54% vs 80%, respectively (P < 0.001). Authors concluded that pre-LT PMA might be predict 1-yr survival post-LT[74].
Van Vugt et al[69] (2017, Europe)	Listed for LT	585	L3-SMI used. 43 to 53 cm2/m2 for men based on the BMI and 41 cm2/m2 for women. Sarcopenia was associated with waiting list mortality in liver transplant candidates with cirrhosis, particularly in patients with lower MELD scores (P < 0.001) [73].
Kim et al[71] (2018, Japan)	LDLT	92	Height normalized psoas muscle thickness (< 15.5 mm/m) at L3. HCC recurrence risk was greater in sarcopenic patients in univariable analysis [HR = 8.06 (1.06–16.70), P = 0.044) and in multivariable analysis [HR = 9.49 (1.18–76.32), P = 0.034][75].
Chae et al[66] (2018, South Korea)	LDLT	408	This study investigated the association between a perioperative decrease in the PMI and patient mortality after LT. A PMI decrease ≤-11.7% between the day before surgery and POD-7 was an independent predictor of patient mortality after LT[70].

Techniques, methods and outcomes to evaluate the success of liver transplantation in patients with sarcopenia and hepatocellular carcinoma. LT: Liver transplant; LDLT: Living-donor LT; SVR: Skeletal muscle mass-to-Visceral fat area ratio; TPV: Total psoas volume; PMA: Psoas muscle area; BMI: Body mass index; L3-SMI: Third lumbar vertebrae- skeletal muscle index; OS: Overall survival; SMI: Skeletal muscle index; HR: Hazards ratio; DFS: Disease free survival; HCC: Hepatocellular carcinoma; TPA: Total psoas area; PMI: Psoas muscle index.