Albumin-muscle density score predicts overall survival in patients with hepatocellular cancer undergoing treatment with transarterial chemoembolization

Albumin-muscle density score predicts overall survival in patients with hepatocellular cancer undergoing treatment with transarterial chemoembolization | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Albumin-muscle density score predicts overall survival in patients with hepatocellular cancer undergoing treatment with transarterial chemoembolization Alexey Surov, Andreas Wienke, Jan Borggrefe, Timo Alexander Auer, and 17 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5282535/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Nov, 2024 Read the published version in Journal of Cancer Research and Clinical Oncology → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose The purpose of the present study was to analyze associations between different skeletal muscle quality parameters and survival in patients with hepatocellular carcinoma (HCC) undergoing treatment with transarterial chemoembolization (TACE). Methods We retrospectively enrolled 784 treatment-naïve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. Intramuscular adipose tissue (IMAT) and skeletal muscle density (SMD) were estimated. Myosteatosis was defined as SMD < 28.0 HU for men and < 23.8 HU for women. Furthermore, albumin-SMD score (ADS) was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on survival, Cox regression model was used. Kaplan-Meier curves were used for survival analysis. Parameters of skeletal muscle quality were compared in univariate and multivariate regression analyses, adjusted for established risk factors. Results In the overall sample, survivors had higher SMD and ADS in comparison to non-survivors. Patients with low ADS had a lower OS than patients with high ADS (8.4 vs 14.3 months, p < 0.001). In alcohol-induced HCC, none of the analyzed parameters of muscle quality influenced survival. In viral induced HCC, patients with low ADS had lower OS than patients with high ADS (8.8 vs 15.7 months, p < 0.001). In patients with non-alcoholic steatohepatitis (NASH), none of the analyzed parameters of muscle quality influenced survival. Conclusions Low ADS is an independent predictor of worse OS in patients with viral-induced HCC undergoing treatment with TACE. In alcohol-induced and NASH-induced HCCs, parameters of muscle quality do not influence OS. hepatocellular cancer skeletal musculature survival transarterial chemoembolization Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Key Points ● In alcohol-induced HCC, parameters of skeletal muscle quality do not predict OS. ● In viral-induced HCC, low albumin-density score is an independent and strong predictor of worse OS. ● In NASH/NAFLD induced HCC, low albumin-density scoe is associated with worse OS. Introduction Hepatocellular carcinoma (HCC) is the most common primary liver cancer and one of the most common causes of cancer-related mortality worldwide (Sung et al. 2021). Cross-sectional imaging like computed tomography (CT) and magnetic resonance imaging (MRI) play an essential role in diagnosis and staging of HCC (Galle et al. 2018). Moreover, both CT and MRI parameters, such as intensity and/or homogeneity of contrast medium enhancement can also provide data about tumor prognosis. For instance, patients with ill-defined tumor margins had worse survival compared to patients with well-defined tumor margins (Mukund et al. 2021). Also peritumoral hypointensity of HCC on MRI in hepatobiliary phase was reported as another imaging biomarker for worse survival and increased tumor recurrence risk (Öcal et al. 2023). Furthermore, cross-sectional imaging can also provide data about patient`s condition. There is evidence in the literature that the status of the skeletal musculature plays a prognostic role in oncology (Surov et al. 2023). So far, low skeletal muscle mass (LSMM) on CT predicts overall survival in patients with HCC both in the curative and in the palliative setting (March et al. 2022). Also, LSMM predicts treatment response and therapy-associated toxicity in HCC (Surov et al. 2021; Mir et al. 2012). Recently, it has been shown that myosteatosis or fatty infiltration of the skeletal musculature plays a greater prognostic role in oncology than LSMM (Aleixo et al. 2020). Some studies also analyzed the prognostic role of myosteatosis in HCC (Fujiwara et al. 2015; Kaibori et al. 2015; Labeur et al. 2019). However, the reported results are conflicting. For instance, Fujiwara et al. reported that myosteatosis is able to predict overall survival in patients with HCC (Fujiwara et al. 2015). Similar results were reported by Kaibori et al. (Kaibori et al. 2015). In the study of Labeur et al., there were no associations between myosteatosis and survival (Labeur et al. 2019). Furthermore, most reports analyzed relationships between myosteatosis and clinical outcomes in a curative setting, i.e. in patients undergoing surgical resection of HCC. In patients with intermediate-stage HCC undergoing treatment with transarterial chemoembolization (TACE), the clinical impact of the skeletal muscle quality is still unclear. Therefore, the purpose of the present study was to analyze the prognostic role of different skeletal muscle quality parameters in patients with HCC, who were treated with TACE. Material and methods This multicentric retrospective study was approved by the Ethics committee of the Medical Association of Rhineland Palatinate, Mainz, Germany (permit number 2021–15913). The other responsible Ethics committees followed this approval. Patients The present work is a sub-analysis of a multicenter retrospective study (Müller et al. 2022). For this study, data from six German tertiary care centers were collected. The inclusion criteria were: 1) TACE performed between January 2010 and December 2020; 2) age > 18 years; 3) a histological- or image-derived HCC diagnosis, based on EASL (European Association for the Study of Liver Disease) criteria; 4) no treatment performed prior to TACE; 5) no liver transplantation or tumor resection performed during the follow-up period after TACE; and 6) computed tomography (CT) performed prior to treatment initiation. The exclusion criteria were: 1) any treatment performed prior to TACE; 2) liver transplantation or tumor resection during the follow-up period after TACE; 3) missing CT images prior to treatment initiation; 4) insufficient image quality (Müller et al. 2022) Overall, 784 patients were included. There were 139 women (17.7%) and 645 men (82.3%) with a mean age of 66.4 ± 9.5 years. Patient and tumor characteristics are given in Table 1 . The following baseline characteristics were collected for the study: demographic data, liver disease status and etiology, laboratory parameters including albumin and bilirubin levels, and tumor growth pattern, number of lesions, and the diameter of the largest target lesion. Table 1 Baseline characteristics of the included patients Variable All patients ( n = 784) Age in years, median (IQR) 67 (60–74) Sex, n (%) Female 139 (17.7) Male 645 (82.3) Etiology, n (%) alcohol 333 (42.5) viral 229 (29.2) NASH 42 (5.4) alcohol + viral 19 (2.4) autoimmune hepatitis 8 (1.0) Hemochromatosis 13 (1.7) alpha-1 antitrypsin deficiency 1 (0.1) cardiac cirrhosis 1 (0.1) cryptogenic 138 (17.6) Child-Pugh stage, n (%) No cirrhosis 82 (10.4) A 394 (50.3) B 260 (33.2) C 48 (6.1) BCLC stage, n (%) 0 10 (1.3) A 219 (27.9) B 388 (49.5) C 137 (17.5) D 30 (3.8) Size of the largest lesion in mm, median (IQR) 40.5 (27.0–60.0) Tumor burden score (TBS), median 5.1 (1.3–24.9) Number of lesions, median (IQR) 2 (1–3) Albumin level, g/L, median (IQR) 35 (30–39) BCLC, Barcelona Clinic Liver Cancer; NASH, non-alcoholic steatohepatitis HCC was staged using the Barcelona Clinic Liver Cancer (BCLC) classification. Diagnosis of HCC was made according to the current guidelines mainly by imaging (CT or dynamic contrast enhanced MRI). In all patients transarterial interventions were performed by experienced board-certified interventional radiologists. Based on the individual decision of the interventionalist, 56.4% of the patients received drug-eluting bead-TACE and 43.6% conventional TACE. Furthermore, tumor burden score (TBS) was calculated as follows: TBS = square root ((maximum tumor diameter) 2 + (number of tumors) 2 ) (Müller et al. 2022). We used the cut off value of 3.36 to discriminate patients with low and moderate/high TBS (Mukund et al. 2021). Analysis of skeletal muscle quality In every case, CT scans (soft tissue window, portal venous phase, and scan thickness of 3–5 mm) at baseline before TACE were used (Suppl. Table 1) The CT scans were collected and transferred to our body composition tool (Fig. 1 ) (Haubold et al. 2024). Thereafter, a segmentation of the skeletal musculature was performed by using the threshold values of − 29 and 150 HU (Haubold et al. 2024). The following parameters of muscle quality were estimated: skeletal muscle density (SMD) and intramuscular adipose tissue (IMAT). Myosteatosis was defined as skeletal muscle density (SMD) < 28.0 HU for men and < 23.8 HU for women, using the thresholds defined by Sjøblom et al. (Sjøblom et al. 2016). Sex-dependent median value was used as threshold for IMAT in our sample. Furthermore, albumin-density score (ADS) was calculated as follows: serum albumin (g/dL) × SMD (HU) (Kim et al. 2023). Also for ADS, sex-dependent median values were used as cut offs. Statistical analysis For statistical analysis SPSS (version 28, IBM SPSS Statistics for Windows, Armonk, NY, USA: IBM corporation) was used. Collected data (convenience sample) were evaluated by means of descriptive statistics such as absolute and relative frequencies for categorical variables and means and standard deviations as well as medians and interquartile ranges (IQR) for continuous variables. Groups were compared by chi-square test for binary outcomes and by t-test for continuous outcomes. Kaplan-Meier curves were used for the analysis of overall survival. The influence of variables on 1-year mortality was evaluated by logistic regression resulting in odds ratios and their confidence intervals as well as p-values. The resulting p-values were interpreted in an exploratory sense. Results For the entire cohort, the parameters of muscle quality are as follows (M ± SD): SMD, 34.5 ± 8.9 HU; IMAT, 1118.4 ± 751.9 cm 3 ; ADS, 1181.2 ± 413.4. Overall, 160 patients (20.4%) had myosteatosis, 393 patients (50.1%) had high IMAT volume values, and 362 patients (50.0%) showed low ADS. Survivors had higher muscle density and ADS in comparison to non-survivors (Table 2 ). There was no difference of IMAT between survivors and non-survivors. The median OS time was 11.4 months. Patients with low ADS had lower OS time in comparison to patients with high ADS (8.4 vs 14.3 months, p < 0.001) (Fig. 2 ). Also, ADS was an independent predictor of 1-year survival (Table 3 ). Table 2 Parameters of skeletal muscle quality in survivors and non survivors in the overall sample. 1 year mortality Survivors Non-Survivors p-value Muscle density, M ± SD 35.4 ± 8.9 33.7 ± 9.0 0.01 IMAT volumen, M ± SD 1147 ± 749 1091 ± 755 0.30 Myosteatosis, n 67 (17.6%) 93 (23.1%) 0.06 ADS, M ± SD 1278 ± 405 1091 ± 401 < 0.01 2 years mortality Muscle density, M ± SD 35.0 ± 9.7 34.3 ± 8.7 0.39 IMAT volumen, M ± SD 1202 ± 742 1088 ± 754 0.06 Myosteatosis, % 44 (20.9%) 116 (20.2%) 0.85 ADS, M ± SD 1309 ± 429 1136 ± 399 < 0.01 3 years mortality Muscle density, M ± SD 35.6 ± 9.9 34.3 ± 8.8 0.16 IMAT volumen, M ± SD 1185 ± 744 1106 ± 753 0.29 Myosteatosis, % 21 (17.4%) 139 (21.0%) 0.36 ADS, M ± SD 1338 ± 415 1155 ± 408 < 0.01 IMAT, intramuscular adipose tissue; ADS, albumin x muscle density score Table 3 Associations between 1-year survival and variables of the skeletal muscle quality in overall sample Univariable analysis Multivariable analysis Covariate OR 95% CI p-value OR 95% CI p-value Myosteatosis (vs normal muscle density) 1.41 (0.99; 2.00) 0.06 1.50 (0.89; 2.52) 0.13 IMAT volumen ( median) 1.08 (0.82; 1.44) 0.57 1.35 (0.95; 1.93) 0.10 Muscle density (< median vs < median) 1.39 (1.05; 1.84) 0.02 0.90 (0.58; 1.40) 0.65 ADS ( median) 2.49 (1.84; 3.36) < 0.01 1.99 (1.28; 3.10) < 0.01 Bilirubin, ≥ 1.2 mg/dl vs < 1.2 mg/dl 2.37 (1.77; 3.16) (1.36; 2.74) < 0.01 TBS, ≥ 3.37 vs < 3.37 1.40 (0.96; 2.04) 0.08 1.20 (0.79; 1.82) 0.39 BSLC stage, C + D vs A + B 3.12 (2.15; 4.54) < 0.01 2.47 (1.58; 3.86) < 0.01 IMAT, intramuscular adipose tissue; ADS, albumin x muscle density score; TBS,tumor burden score; BCLC, Barcelona Clinic Liver Cancer In the next step, relationships between muscle quality and OS according to different etiologies were investigated. In alcohol-induced HCC, 22.7% of the patients had myosteatosis, 51.8% had high IMAT values, and 54.4% showed low ADS. In this subgroup, none of the analyzed parameters of muscle quality influenced survival (Table 4 , Fig. 3 ). Table 4 Associations between 1-year survival and variables of the skeletal muscle quality in patients with alcohol-induced HCC Univariable analysis Multivariable analysis Covariate OR 95% CI p-value OR 95% CI p-value Myosteatosis (vs normal muscle density) 1.13 0.68–1.90 0.63 1.41 0.67–2.97 0.36 IMAT volumen ( median) 1.05 0.68–1.62 0.82 1.32 0.78–2.25 0.31 Muscle density (< median vs < median) 1.18 0.76–1.82 0.46 1.05 0.55–2.00 0.89 ADS ( median) 1.62 1.03–2.54 0.04 1.12 0.58–2.17 0.72 Bilirubin, ≥ 1.2 mg/dl vs < 1.2 mg/dl 2.04 1.31–3.18 < 0.01 1.80 1.06–3.06 0.03 TBS, ≥ 3.37 vs < 3.37 1.31 0.74–2.32 0.36 1.23 0.66–2.27 0.52 BSLC stage, C + D vs 0 + A + B 3.87 2.10–7.14 < 0.01 3.39 1.65–6.93 < 0.01 IMAT, intramuscular adipose tissue; ADS, albumin x muscle density score; TBS,tumor burden score; BCLC, Barcelona Clinic Liver Cancer In viral-induced HCC, 12.4% of the patients had myosteatosis, 38.7% had high IMAT values, and 39.0% showed low ADS. In this subgroup, low ADS was a strong and independent predictor of 1-year survival (Table 5 ). Patients with low ADS had shorter OS time than patients with high ADS (8.8 vs 15.7 months, p < 0.001) (Fig. 4 ). Table 5 Associations between 1-year survival and variables of the skeletal muscle quality in patients with viral-induced HCC Univariable Multivariable Covariate OR 95% CI p-value OR 95% CI p-value Myosteatosis (vs normal muscle density) 0.91 0.41–2.02 0.82 0.75 0.23–2.47 0.64 IMAT volumen ( median) 1.59 0.92–2.74 0.09 1.97 0.94–4.11 0.07 Muscle density (< median vs < median) 1.45 0.83–2.54 0.19 0.88 0.33–2.33 0.79 ADS ( median) 3.02 1.68–5.41 < 0.01 3.88 1.54–9.80 < 0.01 Bilirubin, ≥ 1.2 mg/dl vs < 1.2 mg/dl 2.38 1.39–4.08 < 0.01 1.73 0.87–3.42 0.12 TBS, ≥ 3.37 vs < 3.36 1.42 0.74–2.73 0.29 1.07 0.51–2.28 0.85 BSLC stage, C + D vs 0 + A + B 3.59 1.78–7.27 < 0.01 2.44 1.03–5.78 0.04 IMAT, intramuscular adipose tissue; ADS, albumin x muscle density score; TBS, tumor burden score; BCLC, Barcelona Clinic Liver Cancer Finally, in NASH-induced HCC, 23.8% of the patients had myosteatosis, 47.6% had high IMAT values, and 61.5% showed low ADS. None of the analyzed parameters of muscle quality influenced survival (Table 6 , Fig. 5 ). Table 6 Associations between 1-year survival and variables of the skeletal muscle quality in patients with NASH-induced HCC Univariable Multivariable Covariate OR 95% CI p-value OR 95% CI p-value Myosteatosis (vs normal muscle density) 5.14 0.94–28.1 0.06 8.09 0.425–153 0.16 IMAT volumen (< median) 0.83 0.25–2.80 0.77 0.33 0.04–2.58 0.29 Muscle density (< median) 2.62 0.75–9.13 0.13 2.68 0.25–28.8 0.42 albumin x muscle density (< median) 4.00 1.02–15.7 0.05 0.78 0.07–8.50 0.84 Bilirubin, ≥ 1.2 mg/dl vs < 1.2 mg/dl 8.36 2.02–34.6 < 0.01 39.5 2.59–603 0.01 TBS, ≥ 3.37 vs < 3.36 1.06 0.19–5.98 0.95 0.06 0.01–1.96 0.12 BSLC stage, C + D vs 0 + A + B 3.24 0.72–14.6 0.13 1.95 0.17–22.2 0.59 IMAT, intramuscular adipose tissue; ADS, albumin x muscle density score; TBS,tumor burden score; BCLC, Barcelona Clinic Liver Cancer Discussion The present study demonstrated that low muscle quality represented by myosteatosis, high IMAT, and low ADS are frequent in patients with advanced HCC. More importantly, low ADS is an independent predictor of poor survival in HCC. High IMAT and myosteatosis, however, did not influence survival in our sample. According to the literature, in HCC, parameters of the skeletal muscle quality are significant predictors of overall survival (Aleixo et al. 2020; Fujiwara et al. 2015). However, most previous studies analyzed the predictive role of the musculature in patients undergoing treatment with different kinase inhibitors or hepatectomy (Aleixo et al. 2020). Only two reports studied previously the role of skeletal muscle quality in patients with HCC undergoing treatment with TACE (Bannangkoon et al. 2023; Masetti et al. 2022). Furthermore, the reported data are controversial. For instance, in the study of Bannangkoon et al., patients with myosteatosis had shorter overall survival than those without myosteatosis (15.9 vs. 27.1 months, P < 0.001) (Bannangkoon et al. 2023). However, according to Masetti et al., myosteatosis was not associated with complications or survival in HCC patients undergoing transarterial embolization (Masetti et al. 2022). In summary, previous studies analyzed only myosteatosis or low skeletal muscle density as parameters of low muscle quality. In the present work, we investigated the prognostic role of different values of muscle quality. Recently, a study proposed a combined value of muscle density and albumin level in patients with non-metastatic colorectal cancers (Kim et al. 2023). The authors found that this score was an independent predictor of survival, with superior prognostic value compared to skeletal muscle index, skeletal muscle density or albumin alone (Kim et al. 2023). Serum albumin is a well-known marker of systemic inflammation and nutritional status (Gupta et al. 2010). Albumin reflects the severity of liver functional impairment (Gupta et al. 2010). Hepatic function is a key prognostic marker in patients with HCC and central to patient selection for TACE (Galle et al. 2020). Relationships between skeletal muscle quality and OS in patients with advanced HCC may be caused by several factors. In first instance, low muscle density and ADS are both parameters reflecting malnutrition and low serum albumin level. Furthermore, low muscle quality may be associated with altered endocrine function of the skeletal musculature. It is known that skeletal muscles synthesize and secret several peptides (myokines) with anticancer effects (Park et al. 2023). We hypothesize that low muscle quality reflected by low ADS may be associated with a reduction of myokine synthesis and secretion. This may cause a reduction of circulating and intratumoral immune cells. Interestingly, IMAT values did not influence survival in our sample. This finding indicates that fatty infiltration of the perimuscular space reflected by IMAT may not affect the endocrine and antitumoral effects of the skeletal musculature in contrast to intracellular muscle degeneration reflected by low muscle density. Our study has further important findings. We identified that patients with alcohol-induced HCC and NASH had lower muscle quality than patients with viral-induced HCC. This finding is not unusual and may be related to the known malnutrition in patients with alcoholism. Patients with NASH show systemic metabolic disorders with deposits of adipose tissue within several organs. ADS affected OS in patients with viral-induced HCC but not in alcohol-induced and NASH induced tumors. This phenomenon may be explained by the fact that the frequency of low ADS in patients with alcohol-induced and NASH-induced HCCs is significantly higher than in patients with viral-induced HCC. This finding is of great clinical importance and it indicates that the etiology of HCC should be taken into account when using the skeletal muscle quality to determine treatment strategy. Also, this phenomenon may explain conflicting results of the previous studies. The identified results are highly important for clinical practice. Low muscle quality is a modifiable factor. According to the literature, exercise and an additional nutritional support with vitamins and proteins can improve muscle quality in tumor patients (Marcantei et al. 2024). Therefore, check for low muscle quality, especially for low ADS, and development of supportive regimes may be of benefit for patient with advanced HCC. Overall, our data underlines the importance of the quantitative analysis of body composition in patients with HCC and supports the results of previous investigations (Xiong et al. 2023; Surov et al. 2024). Some limitations of the present study are to address. Firstly, this is a retrospective analysis. Secondly, we excluded patients with missing baseline abdominal CT scan that might lead to selection bias. Thirdly, the NASH cohort in our sample is small and, therefore, our results about the role of muscle quality in this subgroup do not allow drawing definitive conclusions. In conclusion, low ADS is an independent predictor of worse OS in patients with viral-induced HCC undergoing treatment with TACE. In alcohol-induced and NASH-induced HCCs, parameters of muscle quality do not influence OS. Abbreviations ADS, Albumin-density score; BCLC, Barcelona Clinic Liver Cancer classification; CT, computed tomography; TBS, tumor burden score; EASL, European Association for the Study of Liver Disease; HCC, hepatocellular carcinoma; HU, Hounsfield unit; IMAT, intramuscular adipose tissue; OS, overall survival; SMD, skeletal muscle density; TACE, transarterial chemoembolization Declarations Authors’ contributions Study concept, study design, data interpretation, and drafting the manuscript: AS. Data collection: all authors. Analysis and interpretation of data: AS, AW, RK. Critical revision of the manuscript and study supervision: MS, JB, RK. Drafting final manuscript: all authors. Acknowledgements None Statement of Ethics The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. Disclosure Statement The authors declare no conflicts of interest. Funding Sources None References Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin Am Cancer Soc 71:209–249 Galle PR, Forner A, Llovet JM et al (2018) EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 69:182–236 Mukund A, Bhardwaj K, Choudhury A, Sarin SK (2021) Survival and Outcome in Patients Receiving Drug-Eluting Beads Transarterial Chemoembolization for Large Hepatocellular Carcinoma (> 5 cm). J Clin Exp Hepatol 11(6):674–681 Öcal O, Schütte K, Malfertheiner P et al (2023) Prognostic value of baseline MRI features in patients treated with thermal ablation for hepatocellular carcinoma. Eur J Radiol 168:111120 Surov A, Wienke A, Gutzmer R, Borggrefe J (2023) Time to include sarcopenia into the oncological routine. Eur J Cancer 190:112939 March C, Omari J, Thormann M et al (2022) Prevalence and role of low skeletal muscle mass (LSMM) in hepatocellular carcinoma. A systematic review and meta-analysis. Clin Nutr ESPEN 49:103–113 Surov A, Pech M, Gessner D et al (2021) Low skeletal muscle mass is a predictor of treatment related toxicity in oncologic patients. A meta-analysis. Clin Nutr 40(10):5298–5310 Mir O, Coriat R, Blanchet B et al (2012) Sarcopenia predicts early dose-limiting toxicities and pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PLoS ONE 7(5):e37563 Aleixo GFP, Shachar SS, Nyrop KA et al (2020) Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol 145:102839 Fujiwara N, Nakagawa H, Kudo Y et al (2015) Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol 63(1):131–140 Kaibori M, Ishizaki M, Iida H et al (2015) Effect of Intramuscular Adipose Tissue Content on Prognosis in Patients Undergoing Hepatocellular Carcinoma Resection. J Gastrointest Surg 19(7):1315–1323 Labeur TA, van Vugt JLA, Ten Cate DWG et al (2019) Body Composition Is an Independent Predictor of Outcome in Patients with Hepatocellular Carcinoma Treated with Sorafenib. Liver Cancer 8(4):255–270 Müller L, Hahn F, Auer TA et al (2022) Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems. Front Oncol 12:850454 Haubold J, Baldini G, Parmar V et al (2024) BOA: A CT-Based Body and Organ Analysis for Radiologists at the Point of Care. Invest Radiol 59(6):433–441 Sjøblom B, Grønberg BH, Wentzel-Larsen T et al (2016) Skeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer. Clin Nutr 35(6):1386–1393 Kim Y, Lee JH, Cho ES et al (2023) Albumin-myosteatosis gauge as a novel prognostic risk factor in patients with non-metastatic colorectal cancer. J Cachexia Sarcopenia Muscle 14(2):860–868 Hamaguchi Y, Kaido T, Okumura S et al (2015) Preoperative intramuscular adipose tissue content is a novel prognostic predictor after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 22(6):475–485 Bannangkoon K, Hongsakul K, Tubtawee T et al (2023) Association of myosteatosis with treatment response and survival in patients with hepatocellular carcinoma undergoing chemoembolization: a retrospective cohort study. Sci Rep 13(1):3978 Masetti C, Pugliese N, Lofino L et al (2022) Myosteatosis Is Not Associated with Complications or Survival in HCC Patients Undergoing. Trans Arterial Embolization 12(1):262 Gupta D, Lis CG (2010) Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 9:69 Park SY, Hwang BO, Song NY (2023) The role of myokines in cancer: crosstalk between skeletal muscle and tumor. BMB Rep 56(7):365–373 Marcantei C, Couret A, King J et al (2024) Effects of Exercise Training on Muscle Mass and Physical Function in Patients with Hepatocellular Carcinoma After Diagnosis: A Systematic Review. Dig Dis Sci. 10.1007/s10620-024-08441-6 Xiong B, Yang C, Zhu X et al (2023) The Added Value of Sarcopenia on Existing Risk Scores to Predict Mortality after TIPS Placement: A Multicenter Study. Acad Radiol Suppl 1:S246–S256 Surov A, Wienke A, Borggrefe J et al (2024) Skeletal muscle quality predicts overall survival in advanced liver hepatocellular carcinoma treated with SIRT and sorafenib: A subanalysis of the SORAMIC trial. United Eur Gastroenterol J. 10.1002/ueg2.12627 Additional Declarations No competing interests reported. Supplementary Files Suppltable.docx Cite Share Download PDF Status: Published Journal Publication published 30 Nov, 2024 Read the published version in Journal of Cancer Research and Clinical Oncology → Version 1 posted Editorial decision: Revision requested 02 Nov, 2024 Reviews received at journal 02 Nov, 2024 Reviewers agreed at journal 25 Oct, 2024 Reviews received at journal 21 Oct, 2024 Reviewers agreed at journal 20 Oct, 2024 Reviewers invited by journal 19 Oct, 2024 Editor assigned by journal 19 Oct, 2024 Submission checks completed at journal 19 Oct, 2024 First submitted to journal 17 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Surov","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIiWNgGAWjYDACdmTOBwYGxgYIkxm3FmQpxhkka2HmIUYLfzPzMYmPbQz2BrcPH5O2zbGRbWDvMX7Nw2Ath0uLxGG2ZMOZbQyJG86lpUnnbkszbuA5Y2bNw5BujNOawzyGj3nbGBIMzvAYG+duO5zYIJGWZszDAGTg0CF/mP/D4b8gh4G0WG77D9dSj0uLwWEexseMbQyMG84ArWPcdgCoJfnwY6CWBFzuMjzMZmzYc04iceYZtsSHvduSjdt4Dh9jnGOQbojLFrnjzc8kfpTZ2POdYT5w4Oc2O9l+9sbmD28qrOVxeh8EGNkkEBw2IJJgMMCrAQj+oHKZPxDSMApGwSgYBSMKAAApQlFHOd+ncAAAAABJRU5ErkJggg==","orcid":"","institution":"Johannes Wesling University Hospital Minden, Ruhr University Bochum","correspondingAuthor":true,"prefix":"","firstName":"Alexey","middleName":"","lastName":"Surov","suffix":""},{"id":370343562,"identity":"071733a5-709f-4088-8261-14edb0edaf78","order_by":1,"name":"Andreas Wienke","email":"","orcid":"","institution":"Martin-Luther- University Halle-Wittenberg","correspondingAuthor":false,"prefix":"","firstName":"Andreas","middleName":"","lastName":"Wienke","suffix":""},{"id":370343565,"identity":"de5dbfb7-b099-4396-a364-30900118dc2d","order_by":2,"name":"Jan Borggrefe","email":"","orcid":"","institution":"Johannes Wesling University Hospital Minden, Ruhr University Bochum","correspondingAuthor":false,"prefix":"","firstName":"Jan","middleName":"","lastName":"Borggrefe","suffix":""},{"id":370343573,"identity":"242ba7ff-25a9-44cb-9461-5b6c0830b944","order_by":3,"name":"Timo Alexander Auer","email":"","orcid":"","institution":"Charité - University Medicine Berlin","correspondingAuthor":false,"prefix":"","firstName":"Timo","middleName":"Alexander","lastName":"Auer","suffix":""},{"id":370343574,"identity":"60cf05bd-1880-44a3-bec8-ceb2c90b78f1","order_by":4,"name":"Bernhard Gebauer","email":"","orcid":"","institution":"Charité - University Medicine Berlin","correspondingAuthor":false,"prefix":"","firstName":"Bernhard","middleName":"","lastName":"Gebauer","suffix":""},{"id":370343575,"identity":"7590fdc8-0dad-46fb-a8cc-16dd2a9c5448","order_by":5,"name":"Aline Mähringer-Kunz","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Aline","middleName":"","lastName":"Mähringer-Kunz","suffix":""},{"id":370343576,"identity":"fdb5c219-428a-451d-822d-df6baac7126b","order_by":6,"name":"Felix Nensa","email":"","orcid":"","institution":"University Hospital Essen","correspondingAuthor":false,"prefix":"","firstName":"Felix","middleName":"","lastName":"Nensa","suffix":""},{"id":370343577,"identity":"9c8f11e1-3fb0-4cc0-88db-0ee532676f9d","order_by":7,"name":"Johannes Haubold","email":"","orcid":"","institution":"University Hospital Essen","correspondingAuthor":false,"prefix":"","firstName":"Johannes","middleName":"","lastName":"Haubold","suffix":""},{"id":370343578,"identity":"75775ecb-8f45-4904-b589-6184bc43ac28","order_by":8,"name":"Benedikt Michael Schaarschmidt","email":"","orcid":"","institution":"University Hospital Essen","correspondingAuthor":false,"prefix":"","firstName":"Benedikt","middleName":"Michael","lastName":"Schaarschmidt","suffix":""},{"id":370343579,"identity":"57078d5a-4dd3-40ff-8923-a7f0f3cf3c2d","order_by":9,"name":"René Hosch","email":"","orcid":"","institution":"University Hospital Essen","correspondingAuthor":false,"prefix":"","firstName":"René","middleName":"","lastName":"Hosch","suffix":""},{"id":370343580,"identity":"465cef9a-c833-4a91-a240-9eb6aa269344","order_by":10,"name":"Jens Kleesiek","email":"","orcid":"","institution":"University Hospital Essen","correspondingAuthor":false,"prefix":"","firstName":"Jens","middleName":"","lastName":"Kleesiek","suffix":""},{"id":370343581,"identity":"d911b1fc-a819-4808-81db-054e07d87d89","order_by":11,"name":"Thierno D Diallo","email":"","orcid":"","institution":"Freiburg University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Thierno","middleName":"D","lastName":"Diallo","suffix":""},{"id":370343582,"identity":"789bcff0-6221-4b4b-975e-f839e5f7c69a","order_by":12,"name":"Natascha Roehlen","email":"","orcid":"","institution":"Freiburg University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Natascha","middleName":"","lastName":"Roehlen","suffix":""},{"id":370343583,"identity":"d0790d00-05ab-44b2-9e52-15c24acf6ec1","order_by":13,"name":"Dominik Bettinger","email":"","orcid":"","institution":"Freiburg University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dominik","middleName":"","lastName":"Bettinger","suffix":""},{"id":370343584,"identity":"97fb0fe2-390b-43ae-937b-6a08acb2951d","order_by":14,"name":"Michel Eisenblätter","email":"","orcid":"","institution":"Bielefeld University","correspondingAuthor":false,"prefix":"","firstName":"Michel","middleName":"","lastName":"Eisenblätter","suffix":""},{"id":370343585,"identity":"896f6262-baa5-41d9-95af-b441102c7d81","order_by":15,"name":"Verena Steinle","email":"","orcid":"","institution":"University Medical Center Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Verena","middleName":"","lastName":"Steinle","suffix":""},{"id":370343586,"identity":"df4132f5-aacd-428a-b0ee-74d44733de6c","order_by":16,"name":"Philipp Mayer","email":"","orcid":"","institution":"University Medical Center Heidelberg","correspondingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"Mayer","suffix":""},{"id":370343587,"identity":"de32e808-2615-4872-b050-9b22ee79205b","order_by":17,"name":"David Zopfs","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Zopfs","suffix":""},{"id":370343588,"identity":"608fa6db-c6ec-4c4e-bead-7be1fc8a064c","order_by":18,"name":"Daniel Pinto dos Santos","email":"","orcid":"","institution":"University Hospital Cologne","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"Pinto dos","lastName":"Santos","suffix":""},{"id":370343589,"identity":"b0eaccc1-0855-4cf9-8899-f9e140dee660","order_by":19,"name":"Lukas Müller","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Lukas","middleName":"","lastName":"Müller","suffix":""},{"id":370343590,"identity":"3efd21cc-a9c3-4e45-a6a4-400604f1b3d9","order_by":20,"name":"Roman Kloeckner","email":"","orcid":"","institution":"University Hospital of Lübeck","correspondingAuthor":false,"prefix":"","firstName":"Roman","middleName":"","lastName":"Kloeckner","suffix":""}],"badges":[],"createdAt":"2024-10-17 11:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5282535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5282535/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00432-024-06043-3","type":"published","date":"2024-11-30T15:58:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68005462,"identity":"cfa581a3-1174-4dee-b7ca-bc98ef1ef6d7","added_by":"auto","created_at":"2024-11-01 08:39:01","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52488,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative cases of the patient sample with performed segmentation of the skeletal musculature (red) and intramuscular adipose tissue (green).\u003c/p\u003e\n\u003cp\u003ea. Patient with high muscle quality.\u003c/p\u003e\n\u003cp\u003eb. Patient with low muscle quality.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/6ee3728cfa209c757513d13f.jpeg"},{"id":68004315,"identity":"72c97ed7-f94f-4fe0-b589-dad42078faec","added_by":"auto","created_at":"2024-11-01 08:31:01","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32579,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival in patients with low and normal albumin x muscle density scores (ADS) in the overall sample. Patients with low ADS had lower median OS time in comparison to patients with high ADS (8.4 vs 14.3 months, p\u0026lt;0.001).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/ad6c404da7b8c39d985f3b2c.jpeg"},{"id":68004320,"identity":"497b4d44-ea68-4a82-aba0-114b17ec70f2","added_by":"auto","created_at":"2024-11-01 08:31:01","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":163262,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival in patients with low and normal albumin x muscle density scores (ADS) in patients with alcohol-induced HCC.\u003c/p\u003e\n\u003cp\u003ePatients with low albumin x muscle density scores (ADS) had considerably lower median OS time in comparison to patients with normal ADS (13.3 vs 15.3 months, p=0.052).\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/3577376723533dc77fcd702e.jpeg"},{"id":68004316,"identity":"2555b10f-4765-49b6-8449-563a2c7a5b5f","added_by":"auto","created_at":"2024-11-01 08:31:01","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":31933,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival in patients with low and normal albumin x muscle density scores (ADS) in patients with viral-induced HCC.\u003c/p\u003e\n\u003cp\u003ePatients with low ADS had shorter median OS time than patients with high ADS (8.8 vs 15.7 months, p\u0026lt;0.001).\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/d5794eefc3159be78bc7a22e.jpeg"},{"id":68005460,"identity":"e09c2f98-ebe0-4a26-88d8-40274e9df177","added_by":"auto","created_at":"2024-11-01 08:39:01","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":158123,"visible":true,"origin":"","legend":"\u003cp\u003eOverall survival in patients with low and normal albumin x muscle density scores (ADS) in patients with NASH-induced HCC.\u003c/p\u003e\n\u003cp\u003ePatients with low ADS have lower median survival time than patients with high ADS, 12.0 vs 23.7 months, respectively (p=0.12).\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/787b47cd7e08e54cfc247cd6.jpeg"},{"id":70388544,"identity":"a0883e59-a37a-4eb2-80da-11d52187d4f5","added_by":"auto","created_at":"2024-12-02 17:26:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1187497,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/1121ecf8-d4ff-4973-b714-719c1dd8c8ee.pdf"},{"id":68004318,"identity":"b8461246-bb4c-40ba-8c18-e61153bf4f6b","added_by":"auto","created_at":"2024-11-01 08:31:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":19342,"visible":true,"origin":"","legend":"","description":"","filename":"Suppltable.docx","url":"https://assets-eu.researchsquare.com/files/rs-5282535/v1/8e0aeb18c7457c30c325dbfc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Albumin-muscle density score predicts overall survival in patients with hepatocellular cancer undergoing treatment with transarterial chemoembolization","fulltext":[{"header":"Key Points","content":"\u003cp\u003e●\u0026nbsp;In alcohol-induced HCC, parameters of skeletal muscle quality do not predict OS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e●\u0026nbsp;In viral-induced HCC, low albumin-density score is an independent and strong predictor of worse OS.\u003c/p\u003e\n\u003cp\u003e● In NASH/NAFLD induced HCC, low albumin-density scoe is associated with worse OS.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eHepatocellular carcinoma (HCC) is the most common primary liver cancer and one of the most common causes of cancer-related mortality worldwide (Sung et al. 2021).\u003c/p\u003e \u003cp\u003eCross-sectional imaging like computed tomography (CT) and magnetic resonance imaging (MRI) play an essential role in diagnosis and staging of HCC (Galle et al. 2018). Moreover, both CT and MRI parameters, such as intensity and/or homogeneity of contrast medium enhancement can also provide data about tumor prognosis. For instance, patients with ill-defined tumor margins had worse survival compared to patients with well-defined tumor margins (Mukund et al. 2021). Also peritumoral hypointensity of HCC on MRI in hepatobiliary phase was reported as another imaging biomarker for worse survival and increased tumor recurrence risk (\u0026Ouml;cal et al. 2023).\u003c/p\u003e \u003cp\u003eFurthermore, cross-sectional imaging can also provide data about patient`s condition. There is evidence in the literature that the status of the skeletal musculature plays a prognostic role in oncology (Surov et al. 2023). So far, low skeletal muscle mass (LSMM) on CT predicts overall survival in patients with HCC both in the curative and in the palliative setting (March et al. 2022). Also, LSMM predicts treatment response and therapy-associated toxicity in HCC (Surov et al. 2021; Mir et al. 2012).\u003c/p\u003e \u003cp\u003eRecently, it has been shown that myosteatosis or fatty infiltration of the skeletal musculature plays a greater prognostic role in oncology than LSMM (Aleixo et al. 2020). Some studies also analyzed the prognostic role of myosteatosis in HCC (Fujiwara et al. 2015; Kaibori et al. 2015; Labeur et al. 2019). However, the reported results are conflicting. For instance, Fujiwara et al. reported that myosteatosis is able to predict overall survival in patients with HCC (Fujiwara et al. 2015). Similar results were reported by Kaibori et al. (Kaibori et al. 2015). In the study of Labeur et al., there were no associations between myosteatosis and survival (Labeur et al. 2019). Furthermore, most reports analyzed relationships between myosteatosis and clinical outcomes in a curative setting, i.e. in patients undergoing surgical resection of HCC. In patients with intermediate-stage HCC undergoing treatment with transarterial chemoembolization (TACE), the clinical impact of the skeletal muscle quality is still unclear.\u003c/p\u003e \u003cp\u003eTherefore, the purpose of the present study was to analyze the prognostic role of different skeletal muscle quality parameters in patients with HCC, who were treated with TACE.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003e This multicentric retrospective study was approved by the Ethics committee of the Medical Association of Rhineland Palatinate, Mainz, Germany (permit number 2021\u0026ndash;15913). The other responsible Ethics committees followed this approval.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThe present work is a sub-analysis of a multicenter retrospective study (M\u0026uuml;ller et al. 2022). For this study, data from six German tertiary care centers were collected. The inclusion criteria were: 1) TACE performed between January 2010 and December 2020; 2) age\u0026thinsp;\u0026gt;\u0026thinsp;18 years; 3) a histological- or image-derived HCC diagnosis, based on EASL (European Association for the Study of Liver Disease) criteria; 4) no treatment performed prior to TACE; 5) no liver transplantation or tumor resection performed during the follow-up period after TACE; and 6) computed tomography (CT) performed prior to treatment initiation. The exclusion criteria were: 1) any treatment performed prior to TACE; 2) liver transplantation or tumor resection during the follow-up period after TACE; 3) missing CT images prior to treatment initiation; 4) insufficient image quality (M\u0026uuml;ller et al. 2022)\u003c/p\u003e \u003cp\u003eOverall, 784 patients were included. There were 139 women (17.7%) and 645 men (82.3%) with a mean age of 66.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5 years. Patient and tumor characteristics are given in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The following baseline characteristics were collected for the study: demographic data, liver disease status and etiology, laboratory parameters including albumin and bilirubin levels, and tumor growth pattern, number of lesions, and the diameter of the largest target lesion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the included patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;784)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (60\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (17.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e645 (82.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e333 (42.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eviral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e229 (29.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNASH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealcohol\u0026thinsp;+\u0026thinsp;viral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eautoimmune hepatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemochromatosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealpha-1 antitrypsin deficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecardiac cirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecryptogenic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e138 (17.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild-Pugh stage, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo cirrhosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (10.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e394 (50.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e260 (33.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCLC stage, \u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (1.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e219 (27.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e388 (49.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137 (17.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize of the largest lesion in mm, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.5 (27.0\u0026ndash;60.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor burden score (TBS), median\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.1 (1.3\u0026ndash;24.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of lesions, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin level, g/L, median (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (30\u0026ndash;39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eBCLC, Barcelona Clinic Liver Cancer;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eNASH, non-alcoholic steatohepatitis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHCC was staged using the Barcelona Clinic Liver Cancer (BCLC) classification. Diagnosis of HCC was made according to the current guidelines mainly by imaging (CT or dynamic contrast enhanced MRI). In all patients transarterial interventions were performed by experienced board-certified interventional radiologists. Based on the individual decision of the interventionalist, 56.4% of the patients received drug-eluting bead-TACE and 43.6% conventional TACE.\u003c/p\u003e \u003cp\u003eFurthermore, tumor burden score (TBS) was calculated as follows: TBS\u0026thinsp;=\u0026thinsp;square root ((maximum tumor diameter)\u003csup\u003e2\u003c/sup\u003e + (number of tumors)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e) (M\u0026uuml;ller et al. 2022). We used the cut off value of 3.36 to discriminate patients with low and moderate/high TBS (Mukund et al. 2021).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnalysis of skeletal muscle quality\u003c/h3\u003e\n\u003cp\u003eIn every case, CT scans (soft tissue window, portal venous phase, and scan thickness of 3\u0026ndash;5 mm) at baseline before TACE were used (Suppl. Table\u0026nbsp;1) The CT scans were collected and transferred to our body composition tool (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (Haubold et al. 2024). Thereafter, a segmentation of the skeletal musculature was performed by using the threshold values of \u0026minus;\u0026thinsp;29 and 150 HU (Haubold et al. 2024). The following parameters of muscle quality were estimated: skeletal muscle density (SMD) and intramuscular adipose tissue (IMAT). Myosteatosis was defined as skeletal muscle density (SMD)\u0026thinsp;\u0026lt;\u0026thinsp;28.0 HU for men and \u0026lt;\u0026thinsp;23.8 HU for women, using the thresholds defined by Sj\u0026oslash;blom et al. (Sj\u0026oslash;blom et al. 2016). Sex-dependent median value was used as threshold for IMAT in our sample. Furthermore, albumin-density score (ADS) was calculated as follows: serum albumin (g/dL) \u0026times; SMD (HU) (Kim et al. 2023). Also for ADS, sex-dependent median values were used as cut offs.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eFor statistical analysis SPSS (version 28, IBM SPSS Statistics for Windows, Armonk, NY, USA: IBM corporation) was used. Collected data (convenience sample) were evaluated by means of descriptive statistics such as absolute and relative frequencies for categorical variables and means and standard deviations as well as medians and interquartile ranges (IQR) for continuous variables. Groups were compared by chi-square test for binary outcomes and by t-test for continuous outcomes. Kaplan-Meier curves were used for the analysis of overall survival. The influence of variables on 1-year mortality was evaluated by logistic regression resulting in odds ratios and their confidence intervals as well as p-values. The resulting p-values were interpreted in an exploratory sense.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFor the entire cohort, the parameters of muscle quality are as follows (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD): SMD, 34.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 HU; IMAT, 1118.4\u0026thinsp;\u0026plusmn;\u0026thinsp;751.9 cm\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e; ADS, 1181.2\u0026thinsp;\u0026plusmn;\u0026thinsp;413.4. Overall, 160 patients (20.4%) had myosteatosis, 393 patients (50.1%) had high IMAT volume values, and 362 patients (50.0%) showed low ADS. Survivors had higher muscle density and ADS in comparison to non-survivors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no difference of IMAT between survivors and non-survivors. The median OS time was 11.4 months. Patients with low ADS had lower OS time in comparison to patients with high ADS (8.4 vs 14.3 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Also, ADS was an independent predictor of 1-year survival (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParameters of skeletal muscle quality in survivors and non survivors in the overall sample.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e1 year mortality\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Survivors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1147\u0026thinsp;\u0026plusmn;\u0026thinsp;749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1091\u0026thinsp;\u0026plusmn;\u0026thinsp;755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADS, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1278\u0026thinsp;\u0026plusmn;\u0026thinsp;405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1091\u0026thinsp;\u0026plusmn;\u0026thinsp;401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2 years mortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1202\u0026thinsp;\u0026plusmn;\u0026thinsp;742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1088\u0026thinsp;\u0026plusmn;\u0026thinsp;754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADS, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1309\u0026thinsp;\u0026plusmn;\u0026thinsp;429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1136\u0026thinsp;\u0026plusmn;\u0026thinsp;399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3 years mortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1185\u0026thinsp;\u0026plusmn;\u0026thinsp;744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1106\u0026thinsp;\u0026plusmn;\u0026thinsp;753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (21.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADS, M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1338\u0026thinsp;\u0026plusmn;\u0026thinsp;415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1155\u0026thinsp;\u0026plusmn;\u0026thinsp;408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eIMAT, intramuscular adipose tissue; ADS, albumin x muscle density score\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between 1-year survival and variables of the skeletal muscle quality in overall sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis (vs normal muscle density)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.99; 2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.89; 2.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026gt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.82; 1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.95; 1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026lt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.05; 1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.58; 1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADS (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026gt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(1.84; 3.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(1.28; 3.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilirubin, \u0026ge;\u0026thinsp;1.2 mg/dl vs\u0026thinsp;\u0026lt;\u0026thinsp;1.2 mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(1.77; 3.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(1.36; 2.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBS, \u0026ge;\u0026thinsp;3.37 vs\u0026thinsp;\u0026lt;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(0.96; 2.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(0.79; 1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBSLC stage, C\u0026thinsp;+\u0026thinsp;D vs A\u0026thinsp;+\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(2.15; 4.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e(1.58; 3.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eIMAT, intramuscular adipose tissue;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eADS, albumin x muscle density score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTBS,tumor burden score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eBCLC, Barcelona Clinic Liver Cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the next step, relationships between muscle quality and OS according to different etiologies were investigated. In alcohol-induced HCC, 22.7% of the patients had myosteatosis, 51.8% had high IMAT values, and 54.4% showed low ADS. In this subgroup, none of the analyzed parameters of muscle quality influenced survival (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between 1-year survival and variables of the skeletal muscle quality in patients with alcohol-induced HCC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis (vs normal muscle density)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.68\u0026ndash;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.67\u0026ndash;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026gt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.68\u0026ndash;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.78\u0026ndash;2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026lt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76\u0026ndash;1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.55\u0026ndash;2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADS (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026gt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026ndash;2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.58\u0026ndash;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilirubin, \u0026ge;\u0026thinsp;1.2 mg/dl vs\u0026thinsp;\u0026lt;\u0026thinsp;1.2 mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.31\u0026ndash;3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.06\u0026ndash;3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBS, \u0026ge;\u0026thinsp;3.37 vs\u0026thinsp;\u0026lt;\u0026thinsp;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026ndash;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.66\u0026ndash;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBSLC stage, C\u0026thinsp;+\u0026thinsp;D vs 0\u0026thinsp;+\u0026thinsp;A\u0026thinsp;+\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.10\u0026ndash;7.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.65\u0026ndash;6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eIMAT, intramuscular adipose tissue;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eADS, albumin x muscle density score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTBS,tumor burden score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eBCLC, Barcelona Clinic Liver Cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn viral-induced HCC, 12.4% of the patients had myosteatosis, 38.7% had high IMAT values, and 39.0% showed low ADS. In this subgroup, low ADS was a strong and independent predictor of 1-year survival (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Patients with low ADS had shorter OS time than patients with high ADS (8.8 vs 15.7 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between 1-year survival and variables of the skeletal muscle quality in patients with viral-induced HCC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis (vs normal muscle density)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.41\u0026ndash;2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.23\u0026ndash;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026gt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u0026ndash;2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.94\u0026ndash;4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026lt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u0026ndash;2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.33\u0026ndash;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADS (\u0026lt;\u0026thinsp;median vs\u0026thinsp;\u0026gt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.68\u0026ndash;5.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.54\u0026ndash;9.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilirubin, \u0026ge;\u0026thinsp;1.2 mg/dl vs\u0026thinsp;\u0026lt;\u0026thinsp;1.2 mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.39\u0026ndash;4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.87\u0026ndash;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBS, \u0026ge;\u0026thinsp;3.37 vs\u0026thinsp;\u0026lt;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026ndash;2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.51\u0026ndash;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBSLC stage, C\u0026thinsp;+\u0026thinsp;D vs 0\u0026thinsp;+\u0026thinsp;A\u0026thinsp;+\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.78\u0026ndash;7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.03\u0026ndash;5.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eIMAT, intramuscular adipose tissue;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eADS, albumin x muscle density score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTBS, tumor burden score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eBCLC, Barcelona Clinic Liver Cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFinally, in NASH-induced HCC, 23.8% of the patients had myosteatosis, 47.6% had high IMAT values, and 61.5% showed low ADS. None of the analyzed parameters of muscle quality influenced survival (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between 1-year survival and variables of the skeletal muscle quality in patients with NASH-induced HCC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyosteatosis (vs normal muscle density)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026ndash;28.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.425\u0026ndash;153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIMAT volumen (\u0026lt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.25\u0026ndash;2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04\u0026ndash;2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuscle density (\u0026lt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026ndash;9.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.25\u0026ndash;28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealbumin x muscle density\u003c/p\u003e \u003cp\u003e(\u0026lt;\u0026thinsp;median)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.02\u0026ndash;15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u0026ndash;8.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilirubin, \u0026ge;\u0026thinsp;1.2 mg/dl vs\u0026thinsp;\u0026lt;\u0026thinsp;1.2 mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.02\u0026ndash;34.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.59\u0026ndash;603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBS, \u0026ge;\u0026thinsp;3.37 vs\u0026thinsp;\u0026lt;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.19\u0026ndash;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01\u0026ndash;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBSLC stage, C\u0026thinsp;+\u0026thinsp;D vs 0\u0026thinsp;+\u0026thinsp;A\u0026thinsp;+\u0026thinsp;B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026ndash;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.17\u0026ndash;22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eIMAT, intramuscular adipose tissue;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eADS, albumin x muscle density score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eTBS,tumor burden score;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eBCLC, Barcelona Clinic Liver Cancer\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study demonstrated that low muscle quality represented by myosteatosis, high IMAT, and low ADS are frequent in patients with advanced HCC. More importantly, low ADS is an independent predictor of poor survival in HCC. High IMAT and myosteatosis, however, did not influence survival in our sample.\u003c/p\u003e \u003cp\u003eAccording to the literature, in HCC, parameters of the skeletal muscle quality are significant predictors of overall survival (Aleixo et al. 2020; Fujiwara et al. 2015). However, most previous studies analyzed the predictive role of the musculature in patients undergoing treatment with different kinase inhibitors or hepatectomy (Aleixo et al. 2020). Only two reports studied previously the role of skeletal muscle quality in patients with HCC undergoing treatment with TACE (Bannangkoon et al. 2023; Masetti et al. 2022). Furthermore, the reported data are controversial. For instance, in the study of Bannangkoon et al., patients with myosteatosis had shorter overall survival than those without myosteatosis (15.9 vs. 27.1 months, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Bannangkoon et al. 2023). However, according to Masetti et al., myosteatosis was not associated with complications or survival in HCC patients undergoing transarterial embolization (Masetti et al. 2022). In summary, previous studies analyzed only myosteatosis or low skeletal muscle density as parameters of low muscle quality. In the present work, we investigated the prognostic role of different values of muscle quality. Recently, a study proposed a combined value of muscle density and albumin level in patients with non-metastatic colorectal cancers (Kim et al. 2023). The authors found that this score was an independent predictor of survival, with superior prognostic value compared to skeletal muscle index, skeletal muscle density or albumin alone (Kim et al. 2023).\u003c/p\u003e \u003cp\u003eSerum albumin is a well-known marker of systemic inflammation and nutritional status (Gupta et al. 2010). Albumin reflects the severity of liver functional impairment (Gupta et al. 2010). Hepatic function is a key prognostic marker in patients with HCC and central to patient selection for TACE (Galle et al. 2020).\u003c/p\u003e \u003cp\u003eRelationships between skeletal muscle quality and OS in patients with advanced HCC may be caused by several factors. In first instance, low muscle density and ADS are both parameters reflecting malnutrition and low serum albumin level. Furthermore, low muscle quality may be associated with altered endocrine function of the skeletal musculature. It is known that skeletal muscles synthesize and secret several peptides (myokines) with anticancer effects (Park et al. 2023). We hypothesize that low muscle quality reflected by low ADS may be associated with a reduction of myokine synthesis and secretion. This may cause a reduction of circulating and intratumoral immune cells.\u003c/p\u003e \u003cp\u003eInterestingly, IMAT values did not influence survival in our sample. This finding indicates that fatty infiltration of the perimuscular space reflected by IMAT may not affect the endocrine and antitumoral effects of the skeletal musculature in contrast to intracellular muscle degeneration reflected by low muscle density.\u003c/p\u003e \u003cp\u003eOur study has further important findings. We identified that patients with alcohol-induced HCC and NASH had lower muscle quality than patients with viral-induced HCC. This finding is not unusual and may be related to the known malnutrition in patients with alcoholism. Patients with NASH show systemic metabolic disorders with deposits of adipose tissue within several organs. ADS affected OS in patients with viral-induced HCC but not in alcohol-induced and NASH induced tumors. This phenomenon may be explained by the fact that the frequency of low ADS in patients with alcohol-induced and NASH-induced HCCs is significantly higher than in patients with viral-induced HCC. This finding is of great clinical importance and it indicates that the etiology of HCC should be taken into account when using the skeletal muscle quality to determine treatment strategy. Also, this phenomenon may explain conflicting results of the previous studies.\u003c/p\u003e \u003cp\u003eThe identified results are highly important for clinical practice. Low muscle quality is a modifiable factor. According to the literature, exercise and an additional nutritional support with vitamins and proteins can improve muscle quality in tumor patients (Marcantei et al. 2024). Therefore, check for low muscle quality, especially for low ADS, and development of supportive regimes may be of benefit for patient with advanced HCC.\u003c/p\u003e \u003cp\u003eOverall, our data underlines the importance of the quantitative analysis of body composition in patients with HCC and supports the results of previous investigations (Xiong et al. 2023; Surov et al. 2024).\u003c/p\u003e \u003cp\u003eSome limitations of the present study are to address. Firstly, this is a retrospective analysis. Secondly, we excluded patients with missing baseline abdominal CT scan that might lead to selection bias. Thirdly, the NASH cohort in our sample is small and, therefore, our results about the role of muscle quality in this subgroup do not allow drawing definitive conclusions.\u003c/p\u003e \u003cp\u003eIn conclusion, low ADS is an independent predictor of worse OS in patients with viral-induced HCC undergoing treatment with TACE. In alcohol-induced and NASH-induced HCCs, parameters of muscle quality do not influence OS.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADS, Albumin-density score;\u003c/p\u003e\n\u003cp\u003eBCLC, Barcelona Clinic Liver Cancer classification;\u003c/p\u003e\n\u003cp\u003eCT, computed tomography;\u003c/p\u003e\n\u003cp\u003eTBS, tumor burden score;\u003c/p\u003e\n\u003cp\u003eEASL, European Association for the Study of Liver Disease;\u003c/p\u003e\n\u003cp\u003eHCC, hepatocellular carcinoma;\u003c/p\u003e\n\u003cp\u003eHU, Hounsfield unit;\u003c/p\u003e\n\u003cp\u003eIMAT, intramuscular adipose tissue;\u003c/p\u003e\n\u003cp\u003eOS, overall survival;\u003c/p\u003e\n\u003cp\u003eSMD, skeletal muscle density;\u003c/p\u003e\n\u003cp\u003eTACE, transarterial chemoembolization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept, study design, data interpretation, and drafting the manuscript: AS. Data collection: all authors. Analysis and interpretation of data: AS, AW, RK. Critical revision of the manuscript and study supervision: MS, JB, RK. Drafting final manuscript: all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement of Ethics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin Am Cancer Soc 71:209\u0026ndash;249\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalle PR, Forner A, Llovet JM et al (2018) EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 69:182\u0026ndash;236\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMukund A, Bhardwaj K, Choudhury A, Sarin SK (2021) Survival and Outcome in Patients Receiving Drug-Eluting Beads Transarterial Chemoembolization for Large Hepatocellular Carcinoma (\u0026gt;\u0026thinsp;5 cm). J Clin Exp Hepatol 11(6):674\u0026ndash;681\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Ouml;cal O, Sch\u0026uuml;tte K, Malfertheiner P et al (2023) Prognostic value of baseline MRI features in patients treated with thermal ablation for hepatocellular carcinoma. Eur J Radiol 168:111120\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSurov A, Wienke A, Gutzmer R, Borggrefe J (2023) Time to include sarcopenia into the oncological routine. Eur J Cancer 190:112939\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarch C, Omari J, Thormann M et al (2022) Prevalence and role of low skeletal muscle mass (LSMM) in hepatocellular carcinoma. A systematic review and meta-analysis. Clin Nutr ESPEN 49:103\u0026ndash;113\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSurov A, Pech M, Gessner D et al (2021) Low skeletal muscle mass is a predictor of treatment related toxicity in oncologic patients. A meta-analysis. Clin Nutr 40(10):5298\u0026ndash;5310\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMir O, Coriat R, Blanchet B et al (2012) Sarcopenia predicts early dose-limiting toxicities and pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PLoS ONE 7(5):e37563\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAleixo GFP, Shachar SS, Nyrop KA et al (2020) Myosteatosis and prognosis in cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol 145:102839\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujiwara N, Nakagawa H, Kudo Y et al (2015) Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma. J Hepatol 63(1):131\u0026ndash;140\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaibori M, Ishizaki M, Iida H et al (2015) Effect of Intramuscular Adipose Tissue Content on Prognosis in Patients Undergoing Hepatocellular Carcinoma Resection. J Gastrointest Surg 19(7):1315\u0026ndash;1323\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabeur TA, van Vugt JLA, Ten Cate DWG et al (2019) Body Composition Is an Independent Predictor of Outcome in Patients with Hepatocellular Carcinoma Treated with Sorafenib. Liver Cancer 8(4):255\u0026ndash;270\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM\u0026uuml;ller L, Hahn F, Auer TA et al (2022) Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems. Front Oncol 12:850454\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaubold J, Baldini G, Parmar V et al (2024) BOA: A CT-Based Body and Organ Analysis for Radiologists at the Point of Care. Invest Radiol 59(6):433\u0026ndash;441\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026oslash;blom B, Gr\u0026oslash;nberg BH, Wentzel-Larsen T et al (2016) Skeletal muscle radiodensity is prognostic for survival in patients with advanced non-small cell lung cancer. Clin Nutr 35(6):1386\u0026ndash;1393\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim Y, Lee JH, Cho ES et al (2023) Albumin-myosteatosis gauge as a novel prognostic risk factor in patients with non-metastatic colorectal cancer. J Cachexia Sarcopenia Muscle 14(2):860\u0026ndash;868\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamaguchi Y, Kaido T, Okumura S et al (2015) Preoperative intramuscular adipose tissue content is a novel prognostic predictor after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Sci 22(6):475\u0026ndash;485\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBannangkoon K, Hongsakul K, Tubtawee T et al (2023) Association of myosteatosis with treatment response and survival in patients with hepatocellular carcinoma undergoing chemoembolization: a retrospective cohort study. Sci Rep 13(1):3978\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasetti C, Pugliese N, Lofino L et al (2022) Myosteatosis Is Not Associated with Complications or Survival in HCC Patients Undergoing. Trans Arterial Embolization 12(1):262\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta D, Lis CG (2010) Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr J 9:69\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SY, Hwang BO, Song NY (2023) The role of myokines in cancer: crosstalk between skeletal muscle and tumor. BMB Rep 56(7):365\u0026ndash;373\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcantei C, Couret A, King J et al (2024) Effects of Exercise Training on Muscle Mass and Physical Function in Patients with Hepatocellular Carcinoma After Diagnosis: A Systematic Review. Dig Dis Sci. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10620-024-08441-6\u003c/span\u003e\u003cspan address=\"10.1007/s10620-024-08441-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong B, Yang C, Zhu X et al (2023) The Added Value of Sarcopenia on Existing Risk Scores to Predict Mortality after TIPS Placement: A Multicenter Study. Acad Radiol Suppl 1:S246\u0026ndash;S256\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSurov A, Wienke A, Borggrefe J et al (2024) Skeletal muscle quality predicts overall survival in advanced liver hepatocellular carcinoma treated with SIRT and sorafenib: A subanalysis of the SORAMIC trial. United Eur Gastroenterol J. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ueg2.12627\u003c/span\u003e\u003cspan address=\"10.1002/ueg2.12627\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cancer-research-and-clinical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jocr","sideBox":"Learn more about [Journal of Cancer Research and Clinical Oncology](https://www.springer.com/journal/432)","snPcode":"432","submissionUrl":"https://submission.nature.com/new-submission/432/3","title":"Journal of Cancer Research and Clinical Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"hepatocellular cancer, skeletal musculature, survival, transarterial chemoembolization","lastPublishedDoi":"10.21203/rs.3.rs-5282535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5282535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe purpose of the present study was to analyze associations between different skeletal muscle quality parameters and survival in patients with hepatocellular carcinoma (HCC) undergoing treatment with transarterial chemoembolization (TACE).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We retrospectively enrolled 784 treatment-na\u0026iuml;ve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. Intramuscular adipose tissue (IMAT) and skeletal muscle density (SMD) were estimated. Myosteatosis was defined as SMD\u0026thinsp;\u0026lt;\u0026thinsp;28.0 HU for men and \u0026lt;\u0026thinsp;23.8 HU for women. Furthermore, albumin-SMD score (ADS) was calculated as follows: serum albumin (g/dL) \u0026times; SMD (HU). To assess the impact of muscle quality on survival, Cox regression model was used. Kaplan-Meier curves were used for survival analysis. Parameters of skeletal muscle quality were compared in univariate and multivariate regression analyses, adjusted for established risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the overall sample, survivors had higher SMD and ADS in comparison to non-survivors. Patients with low ADS had a lower OS than patients with high ADS (8.4 vs 14.3 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In alcohol-induced HCC, none of the analyzed parameters of muscle quality influenced survival. In viral induced HCC, patients with low ADS had lower OS than patients with high ADS (8.8 vs 15.7 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In patients with non-alcoholic steatohepatitis (NASH), none of the analyzed parameters of muscle quality influenced survival.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLow ADS is an independent predictor of worse OS in patients with viral-induced HCC undergoing treatment with TACE. In alcohol-induced and NASH-induced HCCs, parameters of muscle quality do not influence OS.\u003c/p\u003e","manuscriptTitle":"Albumin-muscle density score predicts overall survival in patients with hepatocellular cancer undergoing treatment with transarterial chemoembolization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-01 08:30:56","doi":"10.21203/rs.3.rs-5282535/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-02T21:03:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-02T16:28:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117946004625997884023491092430179821245","date":"2024-10-25T10:18:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-21T10:47:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103513085641643602226890106485032612553","date":"2024-10-20T22:28:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-19T13:58:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-19T13:21:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-19T13:20:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cancer Research and Clinical Oncology","date":"2024-10-17T11:45:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cancer-research-and-clinical-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jocr","sideBox":"Learn more about [Journal of Cancer Research and Clinical Oncology](https://www.springer.com/journal/432)","snPcode":"432","submissionUrl":"https://submission.nature.com/new-submission/432/3","title":"Journal of Cancer Research and Clinical Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e8a65094-9d16-4213-9127-fd21c0af9170","owner":[],"postedDate":"November 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T17:21:10+00:00","versionOfRecord":{"articleIdentity":"rs-5282535","link":"https://doi.org/10.1007/s00432-024-06043-3","journal":{"identity":"journal-of-cancer-research-and-clinical-oncology","isVorOnly":false,"title":"Journal of Cancer Research and Clinical Oncology"},"publishedOn":"2024-11-30 15:58:25","publishedOnDateReadable":"November 30th, 2024"},"versionCreatedAt":"2024-11-01 08:30:56","video":"","vorDoi":"10.1007/s00432-024-06043-3","vorDoiUrl":"https://doi.org/10.1007/s00432-024-06043-3","workflowStages":[]},"version":"v1","identity":"rs-5282535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5282535","identity":"rs-5282535","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}