Simple Summary: Recent studies have shown that pathological changes of body composition, in
particular reduced muscle mass (sarcopenia) and impaired muscle quality (myosteatosis), are linked
to poor outcomes in a variety of clinical conditions. Hepatocellular carcinoma (HCC) is the most
frequent primary malignant tumor of the liver in the Western hemisphere and remains a prominent
cause of cancer-associated mortality. The present study investigates the prognostic value of alterations
in body composition in predicting perioperative morbidity, mortality and long-term oncological
outcome in HCC using preoperative computed-tomography-based segmentation. Our study found
supporting evidence for the relevance of muscle quality over quantity in a European population
and verifies the predictive role of myosteatosis in patients suffering from HCC, with a particularly
significant value in the earlier perioperative phase.
Abstract: Alterations of body composition, especially decreased muscle mass (sarcopenia) and
impaired muscle quality (myosteatosis), are associated with inferior outcomes in various clinical
conditions. The data of 100 consecutive patients who underwent partial hepatectomy for hepatocellular carcinoma (HCC) at a German university medical centre were retrospectively analysed (May
2008–December 2019). Myosteatosis and sarcopenia were evaluated using preoperative computed tomography-based segmentation. We investigated the predictive role of alterations in body composition on perioperative morbidity, mortality and long-term oncological outcome. Myosteatotic patients
were significantly inferior in terms of major postoperative complications (Clavien–Dindo ≥ 3b; 25%
vs. 5%, p = 0.007), and myosteatosis could be confirmed as an independent risk factor for perioperative morbidity in multivariate analysis (odds ratio: 6.184, confidence interval: 1.184–32.305, p = 0.031).
Both sarcopenic and myosteatotic patients received more intraoperative blood transfusions (1.6 ± 22
vs. 0.3 ± 1 units, p = 0.000; 1.4 ± 2.1 vs. 0.3 ± 0.8 units, respectively, p = 0.002). In terms of long-term
overall and recurrence-free survival, no statistically significant differences could be found between the
groups, although survival was tendentially worse in patients with reduced muscle density (median
survival: 41 vs. 60 months, p = 0.223). This study confirms the prognostic role of myosteatosis in
patients suffering from HCC with a particularly strong value in the perioperative phase and supports
the role of muscle quality over quantity in this setting. Further studies are warranted to validate
these findings.