{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:49:02Z","timestamp":1790423342166,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T00:00:00Z","timestamp":1708992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Limited data exist on the prevalence of myosteatosis (i.e., excess accumulation of fat in skeletal muscles) in hepatocellular carcinoma (HCC) patients, and no systematic review or meta-analysis has been conducted in this context. Methods: We searched for articles published from inception until November 2023 to assess the prevalence of myosteatosis in patients with HCC. Results: Ten studies with 3316 patients focusing on myosteatosis and HCC were included. The overall prevalence of myosteatosis in HCC patients was 50% [95% Confidence Interval (CI): 35\u201365%]. Using the body mass index-based criteria (two studies), the prevalence was 34%, while gender-based criteria (eight studies) yielded 54% (p = 0.31). In Asian studies (n = 8), the prevalence was 45%, compared to 69% in non-Asian countries (two studies) (p = 0.02). For viral-associated HCC (eight studies), the prevalence was 49%, rising to 65% in non-alcoholic fatty liver disease-associated cases (three studies) and 86% in alcoholic liver disease-associated cases (three studies) (p &lt; 0.01). The prevalence of myosteatosis was higher in Child\u2013Pugh class C (3 studies, 91%) than in A (7 studies, 73%) or B (6 studies, 50%) (p = 0.02), but with no difference between Barcelona Clinic Liver Cancer stage A (3 studies, 66%), B (4 studies, 44%) and C (3 studies, 62%) (p = 0.80). Patients with myosteatosis had a significantly higher mortality (six studies) (Relative Risk: 1.35 (95%CI: 1.13\u20131.62, p &lt; 0.01). Conclusion: The prevalence of myosteatosis is high in HCC patients and is associated with more severe liver disease and higher mortality rates.<\/jats:p>","DOI":"10.3390\/cancers16050952","type":"journal-article","created":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T05:20:32Z","timestamp":1709011232000},"page":"952","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prevalence of and Impact on the Outcome of Myosteatosis in Patients with Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7254-4617","authenticated-orcid":false,"given":"Aikaterini","family":"Kamiliou","sequence":"first","affiliation":[{"name":"First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Lekakis","sequence":"additional","affiliation":[{"name":"Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Xynos","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3645-582X","authenticated-orcid":false,"given":"Evangelos","family":"Cholongitas","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece"},{"name":"Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1038\/s41575-019-0186-y","article-title":"A global view of hepatocellular carcinoma: Trends, risk, prevention and management","volume":"16","author":"Yang","year":"2019","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1056\/NEJMra1713263","article-title":"Hepatocellular Carcinoma","volume":"380","author":"Villanueva","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101398","DOI":"10.1016\/j.arr.2021.101398","article-title":"Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia","volume":"70","author":"Ahn","year":"2021","journal-title":"Ageing Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102839","DOI":"10.1016\/j.critrevonc.2019.102839","article-title":"Myosteatosis and prognosis in cancer: Systematic review and meta-analysis","volume":"145","author":"Aleixo","year":"2020","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3046","DOI":"10.1002\/sim.4040","article-title":"Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data","volume":"29","author":"Stijnen","year":"2010","journal-title":"Stat. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/biomet\/26.4.404","article-title":"The use of confidence or fiducial limits illustrated in the case of the binomial","volume":"26","author":"Clopper","year":"1934","journal-title":"Biometrica"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/(SICI)1097-0258(19960330)15:6<619::AID-SIM188>3.0.CO;2-A","article-title":"A likelihood approach to meta-analysis with random effects","volume":"15","author":"Hardy","year":"1996","journal-title":"Stat. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e010247","DOI":"10.1136\/bmjopen-2015-010247","article-title":"Plea for routinely presenting prediction intervals in meta-analysis","volume":"6","author":"Ioannidis","year":"2016","journal-title":"BMJ Open"},{"key":"ref_10","unstructured":"R Core Team (2020). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: http:\/\/www.r-project.org\/index.html."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Yoshikawa, K., Shimada, M., Morine, Y., Ikemoto, T., Saito, Y., Yamada, S., Teraoku, H., and Takao, S. (2023). Clinical impact of myosteatosis measured by magnetic resonance imaging on long-term outcomes of hepatocellular carcinoma after radical hepatectomy. BMC Surg., 23.","DOI":"10.1186\/s12893-023-02188-z"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3978","DOI":"10.1038\/s41598-023-31184-9","article-title":"Association of myosteatosis with treatment response and survival in patients with hepatocellular carcinoma undergoing chemoembolization: A retrospective cohort study","volume":"13","author":"Bannangkoon","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Meister, F.A., Lurje, G., Verhoeven, S., Wiltberger, G., Heij, L., Liu, W.J., Jiang, D., Bruners, P., Lang, S.A., and Ulmer, T.F. (2022). The Role of Sarcopenia and Myosteatosis in Short- and Long-Term Outcomes Following Curative-Intent Surgery for Hepatocellular Carcinoma in a European Cohort. Cancers, 14.","DOI":"10.3390\/cancers14030720"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"892192","DOI":"10.3389\/fonc.2022.892192","article-title":"Myosteatosis can Predict Unfavorable Outcomes in Advanced Hepatocellular Carcinoma Patients Treated With Hepatic Artery Infusion Chemotherapy and Anti-PD-1 Immunotherapy","volume":"12","author":"Yi","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jhep.2015.02.031","article-title":"Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma","volume":"63","author":"Fujiwara","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Masetti, C., Pugliese, N., Lofino, L., Colapietro, F., Ceriani, R., Lleo, A., Poretti, D., Pedicini, V., De Nicola, S., and Torzilli, G. (2022). Myosteatosis Is Not Associated with Complications or Survival in HCC Patients Undergoing Trans Arterial Embolization. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010262"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1159\/000488779","article-title":"Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma","volume":"8","author":"Hamaguchi","year":"2019","journal-title":"Liver Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1007\/s00330-022-08980-4","article-title":"Sarcopenia and myosteatosis are associated with survival in patients receiving immunotherapy for advanced hepatocellular carcinoma","volume":"33","author":"Chen","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/s11605-015-2838-8","article-title":"Effect of Intramuscular Adipose Tissue Content on Prognosis in Patients Undergoing Hepatocellular Carcinoma Resection","volume":"19","author":"Kaibori","year":"2015","journal-title":"J. Gastrointest. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Mardian, Y., Yano, Y., Ratnasari, N., Choridah, L., Wasityastuti, W., Setyawan, N.H., and Hayashi, Y. (2019). Sarcopenia and intramuscular fat deposition are associated with poor survival in Indonesian patients with hepatocellular carcinoma: A retrospective study. BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-1152-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1159\/000484487","article-title":"Preoperative Low Muscle Mass and Low Muscle Quality Negatively Impact on Pulmonary Function in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma","volume":"7","author":"Shirai","year":"2018","journal-title":"Liver Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/jhbp.302","article-title":"Impact of postoperative changes in sarcopenic factors on outcomes after hepatectomy for hepatocellular carcinoma","volume":"23","author":"Kobayashi","year":"2016","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_23","unstructured":"Wells, G.A., Shea, B., and O\u2019Connell, D. (2024, February 11). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-Randomized Studies in Meta-Analyses. Available online: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/biom.12817","article-title":"Quantifying publication bias in meta-analysis","volume":"74","author":"Lin","year":"2018","journal-title":"Biometrics"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Okugawa, Y., Kitajima, T., Yamamoto, A., Shimura, T., Kawamura, M., Fujiwara, T., Mochiki, I., Okita, Y., Tsujiura, M., and Yokoe, T. (2022). Clinical Relevance of Myopenia and Myosteatosis in Colorectal Cancer. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092617"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1016\/j.surg.2022.05.031","article-title":"Prognostic value of myosteatosis and sarcopenia for elderly patients with colorectal cancer: A large-scale double-center study","volume":"172","author":"Chen","year":"2022","journal-title":"Surgery"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1007\/s10147-022-02181-1","article-title":"Prognostic value of myosteatosis in patients with lung cancer: A systematic review and meta-analysis","volume":"27","author":"Feng","year":"2022","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"237","DOI":"10.2478\/raon-2020-0016","article-title":"Sarcopenia and myosteatosis at presentation adversely affect survival after esophagectomy for esophageal cancer","volume":"54","author":"Srpcic","year":"2020","journal-title":"Radiol. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wulan, S.N., Raza, Q., Prasmita, H.S., Martati, E., Maligan, J.M., Mageshwari, U., Fatima, I., and Plasqui, G. (2021). Energy Metabolism in Relation to Diet and Physical Activity: A South Asian Perspective. Nutrients, 13.","DOI":"10.20944\/preprints202108.0442.v1"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"987","DOI":"10.3350\/cmh.2023.0035","article-title":"Association of Visceral Fat Obesity, Sarcopenia, and Myosteatosis with Non-Alcoholic Fatty Liver Disease without Obesity","volume":"29","author":"Kim","year":"2023","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ebadi, M., Tsien, C., Bhanji, R.A., Dunichand-Hoedl, A.R., Rider, E., Motamedrad, M., Mazurak, V.C., Baracos, V., and Montano-Loza, A.J. (2022). Skeletal Muscle Pathological Fat Infiltration (Myosteatosis) Is Associated with Higher Mortality in Patients with Cirrhosis. Cells, 11.","DOI":"10.3390\/cells11081345"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ebadi, M., Tsien, C., Bhanji, R.A., Dunichand-Hoedl, A.R., Rider, E., Motamedrad, M., Mazurak, V.C., Baracos, V., and Montano-Loza, A.J. (2022). Myosteatosis in Cirrhosis: A Review of Diagnosis, Pathophysiological Mechanisms and Potential Interventions. Cells, 11.","DOI":"10.3390\/cells11071216"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1038\/s41598-022-27238-z","article-title":"Association between sarcopenia and clinical outcomes in patients with hepatocellular carcinoma: An updated meta-analysis","volume":"13","author":"Guo","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1002\/ijc.34179","article-title":"The prognostic impact of myosteatosis on overall survival in gynecological cancer patients: A meta-analysis and trial sequential analysis","volume":"151","author":"Cao","year":"2022","journal-title":"Int. J. Cancer"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"111866","DOI":"10.1016\/j.nut.2022.111866","article-title":"Prognostic values of myosteatosis for overall survival in patients with gastric cancers: A meta-analysis with trial sequential analysis","volume":"105","author":"Fang","year":"2023","journal-title":"Nutrition"},{"key":"ref_36","first-page":"389","article-title":"The predictive value of sarcopenia and myosteatosis in trans-arterial (chemo)-embolization treated HCC patients","volume":"16","author":"Long","year":"2024","journal-title":"Aging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e3513","DOI":"10.1002\/dmrr.3513","article-title":"Association between type 2 diabetes and skeletal muscle quality assessed by abdominal computed tomography scan","volume":"38","author":"Kim","year":"2022","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2337\/diacare.26.2.372","article-title":"Association between regional adipose tissue distribution and both type 2 diabetes and impaired glucose tolerance in elderly men and women","volume":"26","author":"Goodpaster","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1038\/s41598-022-24002-1","article-title":"Low thigh muscle strength in relation to myosteatosis in patients with type 2 diabetes mellitus","volume":"13","author":"Huang","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Donnelly, M., Driever, D., Ryan, \u00c9.J., Elliott, J.A., Finnegan, J., McNamara, D., Murphy, I., Conlon, K.C., Neary, P.C., and Kavanagh, D.O. (2023). Obesity, Sarcopenia and Myosteatosis: Impact on Clinical Outcomes in the Operative Management of Crohn\u2019s Disease. Inflamm. Bowel Dis., izad225.","DOI":"10.1093\/ibd\/izad225"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Kang, M.K., Lee, Y.R., Song, J.E., Kweon, Y.O., Tak, W.Y., Jang, S.Y., Park, J.G., and Park, S.Y. (2022). Prognostic Impact of Myosteatosis on Mortality in Hospitalized Patients with COVID-19. Diagnostics, 12.","DOI":"10.3390\/diagnostics12092255"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3007","DOI":"10.1016\/j.clnu.2021.05.031","article-title":"Myosteatosis predicting risk of transition to severe COVID-19 infection","volume":"41","author":"Yi","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/gerona\/glp155","article-title":"Adipose tissue infiltration in skeletal muscle of healthy elderly men: Relationships with body composition, insulin resistance, and inflammation at the systemic and tissue level","volume":"65","author":"Zoico","year":"2010","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5493\/wjem.v3.i3.26","article-title":"Interplay of adipokines and myokines in cancer pathophysiology: Emerging therapeutic implications","volume":"3","author":"Dalamaga","year":"2013","journal-title":"World J. Exp. Med."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/5\/952\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:05:36Z","timestamp":1760105136000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/5\/952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,27]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["cancers16050952"],"URL":"https:\/\/doi.org\/10.3390\/cancers16050952","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,27]]}}}