Abstract Background and Aims Our purpose was to assess the impact of muscle quality on overall survival (OS) in patients with advanced HCC. Methods This is a subanalysis of the SORAMIC trial. Overall, 363 patients were included. The SIRT/Sorafenib treatment group comprised 182 patients and the sorafenib group 181 patients. Myosteatosis was defined as skeletal muscle density (SMD) &lt; 41 HU for patients with a body mass index up to 24.9 kg/m 2 and &lt;33 HU for patients with a body mass index ≥25 kg/m 2 . Albumin‐gauge score was calculated as follows: serum albumin (g/dL) × SMD (HU). To assess the impact of muscle quality on clinical variables and OS, a Cox regression model was used. Hazard ratios are presented together with 95 % confidence intervals (95 % CI). Kaplan‐Meier curves were used for survival analysis. Results In the SIRT/sorafenib cohort, low albumin‐gauge score was an independent predictor of worse OS, HR = 1.74, CI 95% (1.16–2.62), p = 0.01. In the sorafenib cohort, muscle quality parameters did not predict OS. In alcohol‐induced HCC ( n = 129), myosteatosis independently predicted OS, HR = 1.85, CI 95% (1.10; 3.12), p = 0.02. In viral‐induced HCC ( n = 99), parameters of muscle quality did not predict OS. In patients with NASH/Non‐alcoholic fatty liver disease (NAFLD) induced HCC, albumin‐gauge score was a strong independent predictor of worse OS in the subgroup undergoing combined treatment with SIRT and sorafenib, HR = 9.86, CI 95% (1.12; 86.5), p = 0.04. Conclusions Myosteatosis predicts independently worse OS in patients with alcohol‐induced HCC undergoing combined treatment with SIRT and sorafenib. In patients with NASH/NAFLD induced HCC undergoing treatment with SIRT and sorafenib, albumin‐gauge score predicts independently worse OS. Impact and implications Associations between parameters of muscle quality and OS are different in accordance to the treatment strategy and etiology of HCC. These findings highlight the prognostic potential of skeletal muscle quality in patients with advanced HCC.

Skeletal muscle quality predicts overall survival in advanced liver hepatocellular carcinoma treated with SIRT and sorafenib: A subanalysis of the SORAMIC trial