Secondary data extracted from electronic medical records of participants with a confirmed diagnosis of hepatocellular carcinoma (HCC).
Researchers collected data on sociodemographic data (age and sex), lifestyle factors (smoking and alcohol consumption), and comorbidities (liver cirrhosis), as well as anthropometric variables including body weight and BMI.
Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and, reduced muscle mass was determined by CT-based body composition analysis.
The primary outcome was overall survival, defined as the time from initiation of sorafenib therapy to death from any cause, which was estimated using the Kaplan–Meier method.
Participants were categorised according to malnutrition and cachexia status, 51.5% were classified as malnourished, and 37.4% as cachexia.
Malnourished participants had significantly greater weight loss, higher frequency of reduced food intake and lower muscle radiodensity. Cachectic participants exhibited reduced muscle radiodensity and a higher prevalence of low muscularity (67.6% vs. 29.0%, p < 0.001).
In participants with hepatocellular carcinoma treated with sorafenib, GLIM-defined malnutrition and cachexia were independently associated with shorter overall survival. Systemic inflammation was also strongly associated with poor prognosis, with inflamed participants presenting markedly shorter median survival.
GLIM-defined malnutrition was independently linked to poorer overall survival, despite not reaching statistical significance in the initial analysis. Cachexia was also associated with shorter overall survival in both the initial and adjusted analyses.
Sensitivity analysis revealed that the minimum detectable hazard ratios with 80% power were 1.84 for malnutrition and 1.89 for cachexia; with 90% power, they were 2.02 and 2.09, respectively.
Researchers found that only GLIM-defined cachexia showed significant separation of survival curves, whereas GLIM-defined malnutrition did not.
The findings suggest that the survival impact of GLIM-defined malnutrition and cachexia in HCC is closely linked to systemic inflammation. According to the researchers, this supports the view that cancer-related malnutrition in HCC is not solely a consequence of changes in body composition, but part of a wider metabolic inflammatory syndrome.
Researchers noted that nutrition related symptoms and reduced food intake were assessed retrospectively from medical records, which limited the consistency of available data.
Reference:
Giovana A et al. GLIM-defined malnutrition and cachexia are associated with overall survival in patients with hepatocellular carcinoma treated with sorafenib. Clin Nutr ESPEN. 2026. DOI: 10.1016/j.clnesp.2026.105110.
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