Prognostic impact of body composition in hepatocellular carcinoma patients with immunotherapy

This study aims to examine the possible relationship between body composition parameters, sarcopenia, and clinical outcomes in hepatocellular carcinoma (HCC) patients who received immune checkpoint inhibitor (ICI) treatment. Three online databases, including Embase, PubMed, and the Cochrane Library, were thoroughly searched for literature describing the relationship between body composition parameters, sarcopenia, and outcomes of ICI-treated HCC patients from the start of each database to 21 January 2024. The Newcastle-Ottawa Scale was used to rate the quality of the studies. The assessed outcomes included hazard ratio (HR) for OS and PFS, as well as odds ratio (OR) for ORR and DCR. This analysis included a total of 15 articles with a combined patient cohort of 1543 individuals. The results demonstrated that HCC patients with low skeletal muscle index (SMI) had significantly inferior OS (HR: 1.68, <i>p</i> &lt; 0.001), PFS (HR: 1.45, <i>p</i> &lt; 0.001), ORR (OR: 0.64, <i>p</i> = 0.044), and DCR (OR: 0.58, <i>p</i> = 0.009) compared to those with high SMI. The presence of sarcopenia in HCC patients was significantly related to poorer OS (HR: 1.63, <i>p</i> &lt; 0.001) and PFS (HR: 1.48, <i>p</i> &lt; 0.001), as well as a lower ORR (OR: 0.64, <i>p</i> = 0.020) and DCR (OR: 0.58, <i>p</i> = 0.007) in comparison to those without sarcopenia. Subgroup analysis demonstrated that these findings were consistent with the multivariate analysis. Moreover, high subcutaneous adipose index (SAI) levels were associated with better OS (HR: 0.46, <i>p</i> = 0.001) and PFS (HR: 0.68, <i>p</i> = 0.021) than those with low SAI levels. The presence of sarcopenia and low SMI in HCC patients undergoing treatment with ICIs was found to be related to inferior treatment response and reduced long-term effectiveness.