Sarcopenia as a Predictive Factor for Recurrence of Hepatocellular Carcinoma Following Radiofrequency Ablation

BACKGROUND: Sarcopenia is a skeletal muscle mass deficiency and a potential prognostic factor for the recurrence of hepatocellular carcinoma (HCC). OBJECTIVE: To determine whether sarcopenia correlates with the recurrence rate of HCC after curative radiofrequency ablation (RFA) in early and very early HCC. METHODS: We retrospectively reviewed 669 HCC patients who underwent their first curative RFA at Siriraj hospital from 2011 to 2020. Fifty-six patients who were diagnosed with HCC by triple-phase CT scan and had complete response on follow-up CT were included. All patients underwent skeletal muscle index (SMI) assessment at level L3 vertebra and sarcopenia was defined by the cut-off values of 52.4 cm(2)/m(2) for men and 38.5 cm(2)/m(2) for women. We compared patients with and without sarcopenia. Time to recurrence was evaluated by the Kaplan-Meier method. Univariate and multivariate Cox regression analysis was performed. RESULTS: Sarcopenia was present in 37 of 56 patients (66.1%). There was no significant difference between groups except body mass index (BMI) (P<0.001) and serum alanine aminotransferase (ALT) (P=0.035). There was a promising result indicating the difference of time to recurrence between each group (P=0.046) and potential association of sarcopenia with HCC recurrence (HR=2.06; P=0.052). The Child-Pugh score and tumor number were independent risk factors for HCC recurrence (HR=2.04; P=0.005 and HR=2.68; P=0.017, respectively). CONCLUSION: Sarcopenia is a potential prognostic factor for recurrence of HCC in Thai patients who underwent RFA. A larger study is required to properly confirm this association.