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Background  A large-scale Japanese study showed that low skeletal muscle index (SMI) and intramuscular fat (IMF) deposition are associated with hepatocellular carcinoma (HCC) survival. Here, we evaluated the effects of SMI and IMF on the survival of Indonesian HCC patients, whose characteristics differ from those of Japanese patients.    Methods  SMI and mean muscle attenuation (MA) were evaluated using computed tomography images of the third lumbar vertebra (L3) in a prospective cohort of 100 Indonesian HCC patients. Clinical, laboratory and body composition data were analysed using the Kaplan–Meier method and Cox regression model to investigate which factors are associated with prognosis.    Results  Of 100 patients, 31 were diagnosed with sarcopenia (L3 SMI value ≤36.2 cm 2 /m 2  for men and ≤ 29.6 cm 2 /m 2  for women), and 65 had IMF deposition (MA value ≤44.4 HU for men and ≤ 39.3 HU for women). These groups had shorter median survival than the reference groups (both  P  < 0.0001). In multivariable analysis, sarcopenia (hazard ratio [HR], 1.921;  P  = 0.016), IMF deposition (HR, 3.580;  P  < 0.001), Barcelona Clinic Liver Cancer (BCLC) stages C and D (HR: 2.396,  P  < 0.01 and HR: 6.131,  P  < 0.01, respectively), Japan Integrated Staging (JIS) score 4 (HR: 2.067,  P  = 0.020), and male gender (HR: 3.211,  P  < 0.001) were independently associated with mortality.    Conclusion  Sarcopenia and IMF deposition showed superior value in combination with BCLC stage and JIS score for predicting the survival of Indonesian HCC patients. Increased awareness and strategies to prevent or reverse these factors might improve patient outcomes. (Electric word counts: 249).

bmc gastroenterology

“Sarcopenia and intramuscular fat deposition are associated with poor survival in Indonesian patients with hepatocellular carcinoma: a retrospective study”