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Background: Skeletal muscle depletion or sarcopenia has been identified as a poor prognostic factor for various diseases. The aim of this study is to determine whether muscle depletion is a prognostic factor for hepatocellular carcinoma (HCC). Methods: We evaluated 217 consecutive patients with primary HCC. The skeletal muscle cross-sectional area was measured by computed tomography at the third lumbar vertebra (L3), from which the total body fat-free mass (FFM) and L3 skeletal muscle index (L3 SMI) were obtained. The factors contributing to overall survival (OS) were analyzed by univariate and multivariate Cox proportional hazards model. Results: In univariate analysis, FFM ( P = 0.0422), Child-Pugh classification ( P = 0.0058), serum albumin level ( P < 0.0001), serum AFP level ( P < 0.0001), serum proteins induced by vitamin K absence or antagonist-II level ( P < 0.0001), cancer stage ( P < 0.0001), and curability of the initial treatment ( P < 0.0001) were significantly associated with the prognosis of HCC. Multivariate analysis indicated that FFM ( P = 0.0499), albumin level ( P = 0.0398), and curability of the initial treatment ( P = 0.0008) were independent prognostic factors. Sarcopenia was defined as an L3 SMI value of ≤29.0 cm/m for women and ≤36.0 cm/m for men, and 24 patients (11.1 %) have sarcopenia. Sarcopenic patients showed a significantly lower OS than those without sarcopenia ( P = 0.0043). Sarcopenic patients who were overweight (BMI >22) died earlier ( P = 0.0129). Conclusions: Skeletal muscle depletion is an independent prognostic factor. Intervention to prevent muscle wasting might be an effective strategy for improving the outcome of HCC. [ABSTRACT FROM AUTHOR]

Purpose: Oxidative stress plays an important role in liver carcinogenesis. To determine the impact of oxidative stress on the recurrence of stage I/II hepatocellular carcinoma (HCC) after curative treatment, we conducted a prospective case series analysis. Methods: This study included 45 consecutive patients with stage I/II HCC, who underwent curative treatment by surgical resection or radiofrequency ablation at Gifu Municipal Hospital from 2006 to 2007. In these 45 cases, recurrence-free survival was estimated using the Kaplan-Meier method. The factors contributing to HCC recurrence, including the serum levels of derivatives of reactive oxygen metabolites (d-ROM) as an index of oxidative stress, were subjected to univariate and multivariate analyses using the Cox proportional hazards model. Results: The serum levels of d-ROM ( P = 0.0231), α-fetoprotein (AFP, P = 0.0274), and fasting plasma glucose ( P = 0.0400) were significantly associated with HCC recurrence in the univariate analysis. Multivariate analysis showed that the serum levels of d-ROM (hazard ratio [HR] 1.0038, 95 % confidence interval [CI] 1.0002-1.0071, P = 0.0392) and AFP (HR 1.0002, 95 % CI 1.0000-1.0003, P = 0.0316) were independent predictors of HCC recurrence. Kaplan-Meier analysis showed that recurrence-free survival was low in patients with high serum d-ROM (≥570 Carr U, P = 0.0036) and serum AFP (≥40 ng/dL, P = 0.0185) levels. Conclusions: The serum levels of d-ROM and AFP can be used for screening patients with a high risk for HCC recurrence. Patients who show increased levels of these factors require careful surveillance. [ABSTRACT FROM AUTHOR]