Muscle Loss During Treatment Signals Roughly Twofold Higher Death Risk in Liver Cancer

Patients with hepatocellular carcinoma whose skeletal muscle visibly deteriorates between imaging scans face roughly twice the hazard of death compared with those whose muscle mass holds steady, according to a systematic review and meta-analysis published in BMC Cancer. The finding, drawn from fourteen retrospective cohorts totalling 2,844 patients, positions serial muscle measurement as a candidate prognostic biomarker in one of the most common and lethal liver malignancies.

The research team, led by Dianzhe Tian and Xin Lu, pooled hazard ratios from studies that reported imaging-derived skeletal muscle measurements taken at multiple time points during treatment, alongside adjusted Cox model estimates for overall survival. Using a random-effects model, they calculated a combined hazard ratio of 2.28, with a 95 percent confidence interval of 1.72 to 3.01. Statistical heterogeneity across studies was moderate, quantified at an I² of 56 percent, and the 95 percent prediction interval of 1.15 to 4.50 indicated that the strength of the association could vary considerably in future settings.

Of the 2,844 patients included across the cohorts, 2,549 contributed data to the extracted Cox models. The association between dynamic muscle deterioration and poorer overall survival remained directionally consistent across all prespecified sensitivity analyses, suggesting the result was not driven by any single study, definition of muscle loss, or treatment subgroup. Exploratory random-effects meta-regression examined whether the effect differed by treatment modality or by the specific muscle metric used, but it did not detect statistically significant differences, although the authors note that precision in these analyses was limited.

The appeal of dynamic assessment lies in what static measurements may miss. Skeletal muscle deterioration during treatment may capture changes in host vulnerability as the disease and its therapies progress, the authors argue, rather than relying on a single baseline snapshot of body composition. Prior evidence in this area has been fragmented across different treatment settings, imaging metrics and definitions of muscle loss, and the magnitude of the prognostic association has remained uncertain — gaps this synthesis was designed to address.

Despite the strength of the pooled estimate, the authors rate the certainty of the evidence as low, citing risk of bias in the underlying studies, heterogeneity among them, and possible small-study effects. Because all included cohorts were retrospective, the findings describe associations rather than tested interventions. The review explicitly concludes that the current evidence does not demonstrate that preventing muscle loss improves survival, and that whether serial muscle assessment actually improves prediction or clinical decision-making remains to be established. Prospective validation is the stated next requirement before dynamic muscle monitoring can be considered for routine prognostic use in hepatocellular carcinoma.

Subject of Research: The association between dynamic skeletal muscle deterioration and overall survival in hepatocellular carcinoma

Article Title: Dynamic skeletal muscle deterioration predicts poorer survival in hepatocellular carcinoma: a systematic review and meta-analysis

Article References: Tian, D., Li, X., Yang, Z., Hu, Z., Liu, Y., Zhu, S., Zhao, H., Du, S., Liu, S., Zhang, L., Xu, Y., Wang, F., & Lu, X. (2026). Dynamic skeletal muscle deterioration predicts poorer survival in hepatocellular carcinoma: a systematic review and meta-analysis. BMC Cancer. https://doi.org/10.1186/s12885-026-17242-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17242-1

Keywords: hepatocellular carcinoma, skeletal muscle deterioration, meta-analysis, overall survival, prognostic biomarker, hazard ratio, body composition, retrospective cohorts, BMC Cancer, liver cancer, Dynamic, skeletal