Strength in quality: Myosteatosis as a predictor of survival in advanced hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) prognosis remains challenging due to late-stage diagnoses, compounded by the absence of biomarkers to predict treatment response. Therapeutic decisions are guided by the Barcelona Clinic Liver Cancer (BCLC) classification, which stratifies patients based on tumor burden, liver function, and performance status, aiming to optimize treatment outcomes by considering the performance of the individual patient. 1 There is a need for objective and measurable data that is able to assess it. Analysis of body composition on CT or MRI may offer us with potential prognostic imaging biomarkers. Sarcopenia, defined as a reduced skeletal muscle mass and function, has been recognized as such a biomarker. Sarcopenia contributes to a worse prognosis of HCC. While reduced muscle mass is relevant, we should also consider qualitative changes in muscle composition. Myosteatosis is characterised by excessive This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.