Sarcopenia and Frailty in Hepatocellular Carcinoma: From Prognostic Marker to Therapeutic Target: A Narrative Review

Purpose of Review This narrative review summarizes recent evidence supporting sarcopenia as a modifiable therapeutic target rather than merely a prognostic marker in hepatocellular carcinoma (HCC). Recent Findings Sarcopenia is one of the most consistent predictors of adverse outcomes across treatment modalities, including resection, locoregional therapy, systemic therapy, and transplantation. Muscle loss in HCC stems from converging mechanisms such as cirrhosis-related hyperammonemia, tumor-associated cachexia, and immune dysfunction linked to myokine depletion. The rise of MASLD-associated HCC has increased the prevalence of myosteatosis and the sarcopenic obesity phenotype. Sarcopenia can be assessed with imaging or bedside markers such as phase angle. After detection, nutritional therapy including branched-chain amino acids, resistance exercise, and selected pharmacological interventions can preserve muscle mass and functional reserve, ideally incorporated into a prehabilitation program. Summary Incorporating sarcopenia assessment into routine care and pairing nutritional therapy and exercise with all HCC treatment modalities, including transplantation, may improve outcomes.