Objective To investigate the clinical utility of quantitative computed tomography (QCT) in evaluating cachexia in hepatocellular carcinoma (HCC) patients.

Methods The clinical, hematological, and imaging data of 112 patients diagnosed with HCC were collected. According to the diagnostic criteria of cachexia, the patients were divided into cachexia and non-cachexia groups. The clinical data of the two groups were compared, univariate and multivariate logistic regression models were used to analyze the independent risk factors for cachexia in HCC patients, and ROC curves were drawn to explore the diagnostic efficacy of independent risk factors.

Results Among 112 HCC patients, 44 cases (39.3%) were in the cachexia group, and 68 cases (60.7%) were in the non-cachexia group. The results of univariate analysis showed that the differences in clinical indicators (age, Edmondson-Steiner staging), TFA, VFA, and SFA in imaging indicators, and alkaline phosphatase, albumin, erythrocyte, and hemoglobin indicators in hematological indicators were statistically significant between the two groups ( P ＜ 0.05 to P ＜ 0.01). Multivariate analysis showed that SFA and VFA were independent risk factors for cachexia in HCC patients ( P ＜ 0.05). ROC curve results showed that the sensitivity, specificity, cut-off value, and AUC of SFA and VFA were 88.6%, 66.2%, 102.7, 0.834, and 86.4%, 70.6%, 144.5, and 0.825, respectively.

Conclusions QCT-derived SFA and TFA are independent risk factors for cachexia status in HCC patients. QCT can be used as a non-invasive tool to monitor cachexia and nutritional status in HCC patients, aiding in the development of personalized nutritional support strategies, reducing treatment complications, and improving therapeutic outcomes.