关键词: 原发性肝癌, 肌肉减少症, 危险因素, 预后

Abstract: Objective To analyze the risk factors of primary liver cancer complicated with sarcopenia and its impact on the prognosis of patients.Methods A retrospective analysis was conducted on the clinical data of 112 patients with primary liver cancer who were hospitalized in our hospital from November 2017 to June 2019.The patients were divided into the sarcopenia group(33 cases) and the non-sarcopenia group(79 cases) according to whether they were complicated with sarcopenia.The related factors affecting the occurrence of sarcopenia in primary liver cancer were evaluated by Multivariate Logistic regression.All subjects were followed up for 5 years, and the survival curves were plotted using the Kaplan-Meier method to compare the 5-year survival rates among the groups.Results The incidence of sarcopenia in 112 patients with primary liver cancer was 29.46%.The proportions of patients aged ≥ 60 years, smoking history, drinking history, combined underlying diseases, NRS 2002 score ≥3, tumor stage Ⅲ-Ⅳ, and Child-Pugh grade B in the sarcopenia group were all higher than those in the non-sarcopenia group, while the body mass index and albumin level were lower than those in the non-sarcopenia group (P<0.05).In addition, there was a significant difference in skeletal muscle mass index between the two groups, and this difference remained significant even after stratification by gender (P<0.05).Multivariate analysis showed that age ≥60 years (OR=1.941), Child-Pugh grade B (OR=2.683), and nutrition risk screening 2002(NRS2002) score ≥3 (OR=3.404) were all risk factors affecting sarcopenia in primary liver cancer (P<0.05).BMI (OR=0.296) was a protective factor (P<0.05).Kaplan-Meier survival analysis and Log-rank test showed that the median survival time in the sarcopenia group was 36.5 months (95%CI: 28.4-44.6), which was lower than 58.0 months (95%CI: 49.1-66.9) in the non-sarcopenia group.There was a statistically significant difference between the two groups (P<0.05).The 5-year survival rate was also significantly lower (24.24% vs.44.30%), and the Log-rank test for comparing the survival curves of the two groups showed statistically significant differences (χ2=3.961, P<0.05).Univariate analysis showed that, in addition to sarcopenia, age ≥60 years old, lower body mass index, tumor stage Ⅲ-Ⅳ and Child-Pugh grade B were also significantly associated with overall survival (P<0.05).The final model of multivariate Cox regression analysis shows that Sarcopenia (HR=2.861), decreased body mass index (HR=1.268), age ≥60 years old (HR=1.727), tumor stage Ⅲ-Ⅳ (HR=1.980), and Child-Pugh grade B (HR=2.119) were risk factors for overall survival (P<0.05).Conclusion Sarcopenia has a high incidence among patients with primary liver cancer.Its occurrence is related to factors such as age, nutritional status and liver function, and its existence is an independent risk factor for shortening the overall survival period of patients.

Key words: primary liver cancer, sarcopenia, risk factors, prognosis