Bone mineral density does not predict overall survival in patients with advanced hepatocellular carcinoma: A subanalysis of the SORAMIC trial.

Background Low bone mineral density (BMD) is an increasingly recognized marker of skeletal frailty, associated with higher fracture risk and mortality in cancer patients. In advanced hepatocellular carcinoma (HCC), however, the prognostic significance of baseline BMD remains unclear. This exploratory subanalysis of the SORAMIC trial evaluated whether CT-derived BMD predicts overall survival (OS) in patients with unresectable HCC. Methods In this exploratory post-hoc study, 342 patients with unresectable HCC and preserved liver function (Child-Pugh ≤B7) were enrolled in the palliative arm of the SORAMIC trial and randomized to receive either sorafenib monotherapy (n=170) or selective internal radiation therapy (SIRT) plus sorafenib (n=172). BMD (in Hounsfield Units, HU) was measured at the third lumbar vertebra on pre-treatment contrast-enhanced CT scans. Patients were stratified into low and high BMD groups using three definitions: the cohort median (139.5 HU for men, 130.0 HU for women), <160 HU for men and <175 HU for women (Meister criteria), and <160 HU (Jang criteria). Cox regression analyses assessed the impact of BMD on OS. Results Median OS in the overall cohort was 9.9 months. No significant association between BMD and OS was observed in the entire cohort or within the sorafenib and SIRT/sorafenib subgroups. Similar nonsignificant results occurred in alcohol-, viral-, and NASH/NAFLD-induced HCC subgroups. Conclusion Baseline CT-derived BMD does not predict OS in advanced HCC patients, indicating it is not a robust prognostic biomarker in this setting. Low BMD does not affect a patient's resilience to SIRT.