Association of CT-defined sarcopenia with survival and therapeutic response in hepatocellular carcinoma patients receiving transarterial chemoembolization: a meta-analysis

Background The prognostic impact of CT-defined sarcopenia in hepatocellular carcinoma (HCC) patients who received the transarterial chemoembolization (TACE) remains unclear. This study aimed to clarify the impact of CT-defined sarcopenia on survival and therapeutic response in HCC patients receiving TACE. Methods PubMed, Web of Science and CNKI databases were searched up to April 18, 2026. Primary endpoints included the overall survival (OS) and progression-free survival (PFS) and secondary endpoints were objective response rate (ORR) and disease control rate (DCR). Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were combined to evaluate the impact of CT-defined sarcopenia on primary and secondary endpoints. Results Sixteen studies with 3359 cases were included. As for primary outcomes, the presence of CT-defined sarcopenia was significantly related to poorer OS (HR = 1.79, 95% CI: 1.47–2.18, P < 0.001) and PFS (HR = 1.65, 95% CI: 1.42–1.92, P < 0.001). Besides, subgroup analysis stratified by the country, sample size, combination of other therapies, source of HR and defining method of sarcopenia manifested similar findings. As for secondary outcomes, CT-defined sarcopenia was also associated with decreased ORR (OR = 0.55, 95% CI: 0.38–0.81, P = 0.002) and DCR (OR = 0.50, 95% CI: 0.37–0.67, P < 0.001). Conclusion CT-defined sarcopenia was significantly associated with poorer survival and therapeutic response among HCC patients receiving TACE and patients with sarcopenia were more likely to experience worse survival and therapeutic response.