{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:09:01Z","timestamp":1792271341552,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013489","name":"Yakult Bio-Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013489","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP21K08718"],"award-info":[{"award-number":["JP21K08718"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP21K08805"],"award-info":[{"award-number":["JP21K08805"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007449","name":"Takeda Science Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007449","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The cachexia index (CXI), which consists of skeletal muscle, inflammation, and nutritional status, has been associated with prognosis in patients with hepatocellular carcinoma (HCC). We hypothesized that dynamic changes in CXI might be associated with long\u2010term outcomes in HCC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study comprised 131 patients who had undergone primary hepatic resection for HCC between 2008 and 2019. Preoperative CXI (pre\u2010CXI) and postoperative CXI (post\u2010CXI) were calculated by the following formula: skeletal muscle index x serum albumin level \/ neutrophil\u2010to\u2010lymphocyte ratio. Pre\u2010 and post\u2010CXI were classified into two groups (high vs. low). We retrospectively investigated the association of perioperative dynamic changes in CXI with disease\u2010free and overall survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In multivariate analyses, negative HBs\u2010antigen (<jats:italic>p<\/jats:italic>\u2009=\u20090.02), high serum PIVKA\u2010II level (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), poor tumor differentiation (<jats:italic>p<\/jats:italic>\u2009=\u20090.02), multiple tumors (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), microvascular invasion (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), partial resection (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), postoperative complications (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and low\u2010pre\u2010CXI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) were significant predictors of disease\u2010free survival, while high ICG<jats:sub>R15<\/jats:sub> (<jats:italic>p<\/jats:italic>\u2009=\u20090.01), poor tumor differentiation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), multiple tumors (<jats:italic>p<\/jats:italic>\u2009=\u20090.01), postoperative complications (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), low\u2010pre\u2010CXI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and low\u2010post\u2010CXI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) were significant predictors of overall survival. Low\u2010post\u2010CXI was associated with older age (<jats:italic>p<\/jats:italic>\u2009=\u20090.045), larger tumor (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), longer operation time (<jats:italic>p<\/jats:italic>\u2009=\u20090.047), greater intraoperative bleeding (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and intraoperative blood transfusion (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Moreover, dynamic changes in CXI were associated with overall survival in each subgroup of patients with low\u2010pre\u2010CXI (<jats:italic>p<\/jats:italic>\u2009=\u20090.02) or high\u2010pre\u2010CXI (<jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Not only post\u2010CXI but also dynamic changes in CXI from pre\u2010 to post\u2010hepatectomy can be a prognostic indicator of HCC, providing a compelling rationale for aggressive perioperative nutritional and physical interventions to improve long\u2010term outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ags3.12804","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T02:14:47Z","timestamp":1713320087000},"page":"917-926","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The prognostic impact of perioperative dynamic changes in cachexia index in patients with hepatocellular carcinoma"],"prefix":"10.1002","volume":"8","author":[{"given":"Munetoshi","family":"Akaoka","sequence":"first","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1686-3228","authenticated-orcid":false,"given":"Koichiro","family":"Haruki","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery The Jikei University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Yamahata","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery The Jikei University School of Medicine  Tokyo 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