Integrating Muscle Depletion with Barcelona Clinic Liver Cancer Staging to Predict Overall Survival in Hepatocellular Carcinoma

Background: Muscle depletion (MD) is a critical factor that influences clinical outcomes in patients with hepatocellular carcinoma (HCC). Although its role in cancer prognosis is recognized, its integration into widely used prognostic systems remains underexplored. This study aimed to evaluate the prognostic impact of MD on overall survival (OS) in HCC patients and to improve existing noninvasive prognostic models by incorporating MD-related metrics. Methods: A retrospective analysis was conducted on 1072 HCC patients treated at Taipei Tzu Chi Hospital between January 2006 and December 2016. All patients had follow-up data and computed tomography (CT) scans at vertebral level L3 for MD evaluation. Independent prognostic factors for OS were identified using Cox proportional hazards models, and the predictive performance of various prognostic models was assessed through the area under the receiver operating characteristic curve (AUROC). Results: The key independent predictors of OS in HCC patients included hepatitis B virus infection, hepatitis C virus infection, liver cirrhosis, tumor size, serum alpha-fetoprotein levels, and MD-related metrics (psoas muscle-to-spine ratio, psoas muscle-to-vertebral ratio, and myosteatosis). Among existing models, the Barcelona Clinic Liver Cancer (BCLC) stage, the Child–Turcotte–Pugh (CTP) class, and the albumin–bilirubin (ALBI) grade demonstrated robust predictive performance for OS. However, incorporating MD significantly improved the predictive accuracy of these models, with the MD–BCLC model showing the highest AUROC (0.804, 95% CI: 0.777–0.832, p < 0.001). Conclusions: MD is an independent and significant prognostic predictor for patients with HCC. Integrating MD metrics into established systems, particularly the BCLC staging system, markedly improves OS prediction, providing a more comprehensive tool for clinical decision-making in the management of HCC.