Method for evaluating prognosis curative effect of drug treatment of liver cancer patient based on radiomics

Abstract

The invention provides a method for evaluating a prognosis curative effect of drug treatment of a liver cancer patient based on radiomics, and belongs to the technical field of biomedical detection. According to the method, the body composition is evaluated through L3 level CT scanning, sarcopenia (Sarcopenia) is defined by skeletal muscle index (SMI), and muscle steatosis (Myosteatosis) is defined by skeletal muscle density (SMD). Progression-free lifetime (PFS) and overall lifetime (OS) are evaluated, and single-factor and multi-factor Cox regression analyses are performed to identify prognostic factors. Experimental results show that sarcopenia and muscle fatty degeneration are important predictive factors for poor prognosis of HCC patients receiving HAIC combined targeted therapy and immunotherapy, especially sarcopenia, and are independent risk factors of OS. Therefore, the body component detection method plays an important role in prognosis evaluation and treatment decision, and can be well used for prognosis curative effect evaluation of drug treatment of the liver cancer patient.

Description

Technical Field

[0001] The present invention belongs to the field of biomedical detection technology, and specifically relates to a method for evaluating the prognosis and efficacy of drug treatment for liver cancer patients based on imaging omics. Background Art

[0002] Primary liver cancer is the sixth most common cancer and the third leading cause of cancer-related death worldwide, with hepatocellular carcinoma (HCC) accounting for approximately 85% of all cases. Although targeted therapy and immunotherapy have significantly improved the survival outcomes of patients with advanced HCC, the overall survival (OS) rate is still less than 30%. Therefore, more and more studies have begun to focus on treatment strategies that combine locoregional therapy (such as hepatic arterial infusion chemotherapy HAIC) with systemic therapy (such as targeted therapy and immunotherapy). Although these combined strategies have achieved high disease control rates and objective response rates, how to identify specific patient groups that are most likely to benefit from them remains an important challenge.

[0003] Prognostic evaluation of combined treatment for liver cancer is crucial for treatment selection and patient management. Currently, the evaluation methods mainly include clinical pathological characteristics, molecular markers, imaging characteristics, and comprehensive models, which are described as follows:

[0004] 1. Clinical and pathological characteristics

[0005] Commonly used indicators include: tumor size, number, degree of differentiation, vascular invasion, lymph node metastasis, etc. The advantages of this method are: characteristic indicators are easy to obtain and low cost; the disadvantages are: the prediction ability of a single indicator is limited and the accuracy is poor, and it needs to be combined with other methods for further evaluation.

[0006] 2. Molecular markers

[0007] Commonly used markers include: AFP, AFP-L3, DCP, GPC3, miRNA, etc. The advantages of this method are: it is helpful for early diagnosis, prognosis evaluation and individualized treatment; but the disadvantages are: its sensitivity and specificity are poor, and there is a lack of unified standards.

[0008] 3. Imaging characteristics

[0009] Commonly used technologies include: CT, MRI, PET-CT, etc. The advantages of these methods are: non-invasive, repeatable, and provide tumor morphology and function information; the disadvantages are: dependence on equipment and doctor experience, and lack of unified standards.

[0010] 4. Comprehensive Model

[0011] Commonly used models include: TNM staging, BCLC staging, CLIP score, MELD score, etc. Its advantages are: it integrates multiple factors and has strong predictive ability; its disadvantages are: some models are complex and their clinical application is limited.

[0012] Recent studies have increasingly emphasized the critical role of nutritional status in cancer prognosis. Sarcopenia (characterized by decreased muscle mass) and myosteatosis (indicating impaired muscle quality) have been identified as key factors associated with poor clinical outcomes in HCC patients.

[0013] However, these studies have several limitations: (1) most studies focused on the relationship between body composition and a single treatment modality (such as surgery, interventional therapy, targeted therapy, immunotherapy, or radiotherapy); (2) most studies used sarcopenia as the primary indicator, which mainly reflects changes in muscle quantity but cannot accurately capture changes in muscle mass; (3) although one study explored the relationship between sarcopenia and the prognosis of HCC patients receiving interventional therapy combined with targeted therapy and immunotherapy, the study combined two different interventional treatments—transarterial chemoembolization (TACE) and HAIC—and only focused on sarcopenia.

[0014] Therefore, how to provide an accurate efficacy prediction and evaluation method for the combined targeted and immunotherapy of hepatocellular carcinoma (HCC) with hepatic arterial chemoembolization (HAIC) to screen potential beneficiaries has become a technical problem that needs to be solved urgently. Summary of the invention

[0015] The present invention is to solve the above technical problems, thereby providing a method for evaluating the prognosis and efficacy of drug treatment for liver cancer patients based on imaging omics. The technical purpose of the present invention is to propose a method for effectively evaluating the prognosis and efficacy of hepatocellular carcinoma patients who receive hepatic artery infusion chemotherapy combined with targeted therapy and immunotherapy by detecting the patient's body composition data.

[0016] In order to achieve the above technical objectives, the technical solution adopted by the present invention is as follows:

[0017] The present invention provides a method for evaluating the prognosis and efficacy of drug treatment for liver cancer patients based on radiomics, comprising the following steps:

[0018] (1) Using CT scans, we identified and quantified the body composition of skeletal muscle, subcutaneous fat, visceral fat, and their total cross-sectional area at the L3 level in patients with liver cancer;

[0019] (2) The skeletal muscle index (SMI) and skeletal muscle density (SMD) were calculated. The sex-specific median skeletal muscle index (SMI) was defined as the critical value for sarcopenia, and the sex-specific median skeletal muscle density (SMD) was defined as the critical value for myosteatosis. The progression-free survival (PFS) and overall survival (OS) of patients were evaluated to predict the prognostic efficacy of drug treatment in patients with liver cancer.

[0020] Furthermore, the body composition threshold ranges of the L3 level of liver cancer patients in step (1) are as follows: skeletal muscle is -29HU to 150HU, subcutaneous fat is -190HU to -30HU, and visceral fat is -150HU to -50HU.

[0021] Furthermore, the skeletal muscle density in step (2) is measured by obtaining the average HU value of the muscles at the L3 level.

[0022] Furthermore, the calculation formula of the skeletal muscle index in step (2) is: skeletal muscle area (cm2) / height (m2).

[0023] Furthermore, the median critical value of the skeletal muscle index for male sarcopenia determined in step (2) is 47.1 cm2 / m2, and the median critical value of the skeletal muscle index for female sarcopenia is 38.2 cm2 / m2.

[0024] Furthermore, the median critical value of skeletal muscle density for myosteatosis in males determined in step (2) is 40.8 HU, and the median critical value of skeletal muscle density for myosteatosis in females is 38.9 HU.

[0025] Furthermore, the progression-free survival (PFS) and overall survival (OS) described in step (2) were estimated using the Kaplan-Meier method and compared by the Log-rank test.

[0026] Furthermore, the liver cancer patient is a hepatocellular carcinoma patient receiving hepatic artery infusion chemotherapy combined with targeted therapy and immunotherapy.

[0027] Furthermore, the targeted therapy is treatment with tyrosine kinase inhibitors, and the immunotherapy is treatment with anti-programmed cell death protein 1 drugs.

[0028] The beneficial effects of the present invention are as follows:

[0029] The present invention evaluates body composition by CT scanning at the L3 level, sarcopenia is defined by skeletal muscle index (SMI), and myofatidis is defined by skeletal muscle density (SMD). Progression-free survival (PFS) and overall survival (OS) were evaluated, and univariate and multivariate Cox regression analysis was performed to identify prognostic factors. The results showed that sarcopenia and myofatidis are important predictors of poor prognosis in HCC patients receiving HAIC combined with targeted therapy and immunotherapy, especially sarcopenia, which is an independent risk factor for OS. Therefore, the method of the present invention is of great significance in the prognosis assessment and treatment decision-making of patients with liver cancer. BRIEF DESCRIPTION OF THE DRAWINGS

[0030] Figure 1 Cross-sectional computed tomography (CT) scans measuring the skeletal muscle area (green) at the L3 vertebral level; (A) in a sarcopenic patient, the skeletal muscle index (SMI) was 38.74 cm 2 / m 2 (B) Non-sarcopenic patients, skeletal muscle index (SMI) is 61.99cm 2 / m 2 ; (C) In patients with myosteatosis, the skeletal muscle density (SMD) was 35.53HU; (D) In ​​patients without myosteatosis, the skeletal muscle density (SMD) was 56.62HU.

[0031] Figure 2 Progression-free survival (PFS) and overall survival (OS) of patients in different groups; (A and B) PFS curves of sarcopenia group and non-sarcopenia group; (C and D) OS curves of sarcopenia group and non-sarcopenia group. DETAILED DESCRIPTION

[0032] In order to make the purpose, technical scheme and advantages of the present invention clearer, the present invention is described in detail below in conjunction with the embodiments. It is necessary to point out that the following embodiments are only used to explain and illustrate the present invention and are not used to limit the present invention. Some non-essential improvements and adjustments made by those skilled in the art based on the above invention content still belong to the protection scope of the present invention.

[0033] Example 1

[0034] 1. Experimental Materials and Methods

[0035] (I) Experimental patients

[0036] This experiment was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Affiliated Cancer Hospital of Fudan University (FUSCC). The subjects were patients diagnosed with hepatocellular carcinoma (HCC) from the Department of Liver Surgery who received hepatic arterial infusion chemotherapy (HAIC) combined with targeted therapy (tyrosine kinase inhibitors, TKIs) and immunotherapy (anti-programmed cell death protein 1, anti-PD-1) drugs from January 2021 to October 2024.

[0037] Patients met the following inclusion criteria: age ≥18 years; Karnofsky performance status (KPS) ≥80; Child-Pugh grade A / B liver function; at least one measurable intrahepatic lesion according to response evaluation criteria in solid tumors (mRECIST); and normal organ function [absolute neutrophil count ≥1.2×10 9 / L, platelet count ≥60×10 9 / L, total bilirubin (T-BIL) <30 μmol / L, albumin (ALB) ≥30 g / L, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤5 times the upper limit of normal, creatinine clearance ≤1.5 times the upper limit of normal, and left ventricular ejection fraction ≥45%]. Patients were excluded if they received other HCC treatments during combined treatment, or were diagnosed with other malignancies, or their medical records and follow-up data were incomplete.

[0038] (II) Treatment process

[0039] The femoral artery was punctured using the Seldinger technique, and a catheter was inserted into the hepatic artery under the guidance of digital subtraction angiography (DSA). The chemotherapy regimen for HAIC was: oxaliplatin 85 mg / m2 was infused from 0 to 2 hours on day 1. 2 ; Fluorouracil 400 mg / m2 infused over 2 to 3 hours on day 1 2 IV push; 3-hour infusion of fluorouracil 400 mg / m on day 1 2 IV push; plus a total of 2400 mg / m on days 1 and 2 2Fluorouracil was continuously infused for 46 hours. Chemotherapy was delivered in the ward via a catheter. HAIC was repeated every 3 weeks. Targeted therapy (TKIs) [lenvatinib: 12 mg per day for patients weighing ≥60 kg and 8 mg per day for patients weighing <60 kg; apatinib 250 mg per day; dorafenib 200 mg per day, taken in 2 divided doses] was started on the first day after the initial intervention and was discontinued from the day before each intervention until the catheter was removed. Anti-PD-1 antibodies (tislelizumab, 200 mg every 3 weeks; sintilimab, 200 mg every 3 weeks; toripalimab, 240 mg every 3 weeks) were intravenously injected once every 3 weeks. Dose adjustments and treatment interruptions were determined based on disease progression, unacceptable toxicity, patient withdrawal of consent or change in treatment regimen, and technical difficulties in repeat interventions. After the start of treatment, enhanced computed tomography (CT) or magnetic resonance imaging (MRI) was performed every 6 weeks to assess the efficacy of treatment.

[0040] 3. Body composition assessment

[0041] The cross-sectional areas of skeletal muscle, subcutaneous fat, visceral fat, and their total volume at L3 were identified and quantified in Hounsfield units (HU) by two investigators independently and blindly using Slice-O-Matic software (version 5.0; Tomovision, Montreal, Canada). The threshold ranges were defined as follows: skeletal muscle was defined as −29 HU to 150 HU, subcutaneous fat was defined as −190 HU to −30 HU, and visceral fat was defined as −150 HU to −50 HU ( Figure 1 ). The body mass index (BMI) is calculated by dividing body weight (kg) by height (m2). According to the World Health Organization's classification, a BMI below 18.5 is considered underweight, a BMI between 18.5 and 24.9 is considered normal weight, and a BMI of 25 or higher is considered overweight. The skeletal muscle index (SMI) is an internationally recognized standard for assessing muscle mass and is commonly used to assess sarcopenia. In the present invention, SMI is used as a standard for assessing sarcopenia. The calculation formula for SMI is: skeletal muscle area (cm 2 ) / Height(m) 2 ). Given that there is no precise definition of sarcopenia in the Chinese population, the present invention defines the patient's gender-specific median SMI as the critical value of sarcopenia. Multiple studies have shown that skeletal muscle density (SMD) is negatively correlated with myosteatosis. SMD is measured by obtaining the average HU value of L3 level muscle. We define the patient's gender-specific median SMD as the critical value of myosteatosis.

[0042] 4. Statistical analysis

[0043] Clinical pathological characteristics and treatment-related adverse events (TRAEs) between the two groups were compared by chi-square test or Fisher's exact test. Tumor response data were analyzed by ordered logistic regression. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared by Log-rank test. Factors with P values ​​< 0.05 in univariate analysis were considered for inclusion in the multivariate Cox proportional hazards model. All P values ​​were two-sided, and P values ​​< 0.05 were considered statistically significant.

[0044] (V) Experimental results

[0045] 1. Patient characteristics

[0046] This study enrolled 158 patients with hepatocellular carcinoma (HCC) between January 2021 and October 2024. The baseline characteristics of the included patients are shown in Table 1. As the cutoff value for sarcopenia, the median skeletal muscle index (SMI) of male patients was 47.1 cm 2 / m 2 , female patients are 38.2cm 2 / m 2 The median skeletal muscle density (SMD) as the cutoff value for myosteatosis was 40.8 HU in male patients and 38.9 HU in female patients.

[0047] Table 1 Baseline characteristics of included patients

[0048]

[0049]

[0050]

[0051]

[0052] There were no significant differences between the sarcopenia group and the non-sarcopenia group in most epidemiological factors, including age at diagnosis (P = 0.117), sex distribution (P = 0.822), Nutritional Risk Screening 2002 (NRS-2002) score (P = 0.482), hepatitis B virus infection (P = 0.482), hepatitis C virus infection (P = 0.999), hypertension (P = 0.391), diabetes (P = 0.416), smoking history (P = 0.699), and alcohol history (P = 0.685). Similarly, there were no significant differences in most liver function characteristics, such as cirrhosis (P = 0.867) and Child-Pugh liver function grade (P = 0.617). In addition, several characteristics of liver tumors, such as alpha-fetoprotein (AFP) level (P = 0.873), tumor number (P = 0.576), portal vein tumor thrombus (P = 0.869), extrahepatic metastasis (P = 0.375), and BCLC stage (P = 0.874), were similar between the two groups. However, the sarcopenia group had a lower BMI (P < 0.001) and a higher ALBI ratio (P = 0.006), which were significantly different from those of the non-sarcopenia group.

[0053] In addition, patients in the myosteatosis group were older (P = 0.001), had less hepatitis B virus infection (P = 0.003), had a more frequent history of hypertension (P = 0.038), and had a higher ALBI ratio (P = 0.049) than those in the non-myosteatosis group.

[0054] 2. Treatment effect

[0055] The tumor responses of patients in different groups are shown in Table 2. According to the mRECIST criteria, the overall response rate (ORR) of all patients was 53.4%, and the disease control rate (DCR) was 77.9%. There was no statistical difference in ORR and DCR between the sarcopenia group and the non-sarcopenia group, or between the myosteatosis group and the non-myosteatosis group.

[0056] Table 2 Tumor response of patients in different groups

[0057]

[0058] 3. Security

[0059] No treatment-related deaths occurred in the enrolled patients, and treatment-related adverse events (TRAEs) are shown in Table 3. TRAEs occurred in 98.7% of patients in the sarcopenia group and 96.2% in the non-sarcopenia group. In the sarcopenia group, the most common TRAEs were fatigue (59.5%), hypoalbuminemia (55.7%), and increased ALT levels (45.6%). Similarly, the most common TRAEs in the non-sarcopenia group were hypoalbuminemia (53.2%), fatigue (50.6%), and nausea (48.1%). The incidence of nausea of ​​any grade was lower in the sarcopenia group (30.4% vs 48.1%, P = 0.023), and the incidence of grade 3 / 4 diarrhea was lower (1.3% vs 10.1%, P = 0.034), which was significantly different from the non-sarcopenia group.

[0060] Table 3 Treatment-related adverse events in included patients

[0061]

[0062]

[0063]

[0064] In the myosteatosis group, 98.8% of patients experienced TRAEs, compared with 96.2% in the non-myosteatosis group. In the myosteatosis group, the most common TRAEs included hypoalbuminemia (56.3%), fatigue (53.8%), and increased ALT levels (46.3%). Similarly, in the non-myosteatosis group, the most common TRAEs were hypoalbuminemia (52.6%), fatigue (56.4%), nausea (43.6%), and increased ALT levels (43.6%). No significant difference was found in the incidence of TRAEs between the two groups.

[0065] 4. Survival Outcome

[0066] The median follow-up time was 16.99 months (range: 2.83-41.30 months). There was a significant difference between the sarcopenia group and the non-sarcopenia group (9.53 months vs 13.87 months, P = 0.536, Figure 2 (A) and between the myosteatosis group and the non-myosteatosis group (10.57 months vs 9.23 months, P = 0.368, Figure 2There was no significant difference in median progression-free survival (PFS) in the middle B). In patients with sarcopenia, the PFS at 3, 6, and 12 months was 89.6%, 74.4%, and 37.5%, respectively. In contrast, the PFS of patients in the non-sarcopenia group was 93.6%, 77.7%, and 50.1%, respectively. In the myosteatosis group, the PFS at 3, 6, and 12 months was 89.8%, 76.5%, and 47.0%, respectively. The corresponding PFS in the non-myosteatosis group was 93.5%, 75.8%, and 44.6%.

[0067] The median overall survival (OS) of the sarcopenia group was 20.80 months, while that of the non-sarcopenia group was 35.97 months (P = 0.005, Figure 2 In the sarcopenia group, the OS at 3, 6, and 12 months was 92.4%, 75.2%, and 65.0%, respectively. In contrast, the OS in the non-sarcopenia group was 98.7%, 94.9%, and 84.4%, respectively. Similarly, the median OS in the myosteatosis group (20.80 months) was significantly shorter than that in the non-muscle steatosis group (35.97 months) (P = 0.021, Figure 2 In the myosteatosis group, the 3-, 6-, and 12-month OS were 92.5%, 75.5%, and 69.8%, respectively, compared with 98.7%, 94.9%, and 79.9%, respectively, in the non-myosteatosis group.

[0068] 5. Univariate and multivariate survival analysis

[0069] The results of univariate and multivariate analysis are presented in Tables 4 and 5, respectively. Multivariate analysis showed that the independent risk factor for PFS was AFP level (≤400 ng / mL vs >400 ng / mL, HR: 0.592, 95% CI: 0.361-0.971; P = 0.038). Multivariate analysis for OS showed that gender distribution (male vs female, HR: 0.513, 95% CI: 0.270-0.975; P = 0.042), BMI (<18.5 vs 18.5-23.9 vs ≥24, HR: 1.896, 95% CI: 1.025-3.506; P = 0.041), AFP level (≤400 ng / mL The prognostic factors were skeletal muscle fat degeneration (single vs multiple, HR: 0.484, 95% CI: 0.291-0.805; P = 0.005), number of tumors (single vs multiple, HR: 0.215, 95% CI: 0.051-0.917; P = 0.038), and sarcopenia (yes vs no, HR: 0.527, 95% CI: 0.311-0.893; P = 0.017). Although myosteatosis was a significant factor affecting OS in univariate analysis (P = 0.021), no statistical difference was found in multivariate analysis (P = 0.109).

[0070] Table 4 Overall survival rate in univariate and multivariate analysis

[0071]

[0072]

[0073]

[0074] Table 5 Univariate and multivariate analysis of progression-free survival

[0075]

[0076]

[0077] 6. Conclusion

[0078] The results of this study showed that sarcopenia and muscle steatosis can predict poor prognosis in patients with hepatocellular carcinoma who received HAIC combined with targeted therapy and immunotherapy, among which sarcopenia was identified as an independent risk factor for overall survival (OS). This suggests that changes in body composition are associated with the efficacy of triple therapy for hepatocellular carcinoma. However, sarcopenia and muscle steatosis were not significantly correlated with objective response rate (ORR), disease control rate (DCR), or progression-free survival (PFS).

[0079] The results of the present study showed that although the incidence of disease progression (PD) in the sarcopenia group was higher than that in the non-sarcopenia group (a similar trend was observed when comparing the myosteatosis group with the non-muscle steatosis group), the difference did not reach statistical significance. The ORR and DCR of the two groups were similar. Therefore, dynamic monitoring of changes in the patient's body composition, such as SMI and SMD, may be more helpful in predicting the treatment effect.

[0080] The results of the present study showed that the types of treatment-related adverse events (TRAEs) in the sarcopenia group were similar to those in the non-sarcopenia group. However, the incidence of nausea and severe diarrhea was lower in the sarcopenia group. This may be related to the relatively low body fat percentage in sarcopenic patients, which affects the distribution and metabolism of certain anti-tumor drugs, especially fat-soluble drugs. This change may reduce the direct effects of these drugs on the gastrointestinal tract, thereby reducing the risk of nausea. In addition, sarcopenic patients usually have a lower body weight, which may lead to adjustments in drug doses based on body weight or body surface area. These dose adjustments help reduce gastrointestinal side effects, including nausea and severe diarrhea.

[0081] The present study found that there was no significant difference in PFS (progression-free survival) between patients with sarcopenia and those without sarcopenia after triple therapy. Although most studies have reported a correlation between sarcopenia and shorter PFS, these studies generally focus on a single treatment modality, such as surgery, targeted therapy, or radiotherapy. The effect of sarcopenia on the efficacy of combined targeted therapy and immunotherapy remains controversial, and some literature indicates that sarcopenia does not affect the PFS of patients treated with atezolizumab and bevacizumab. In this study, patients received HAIC combined with targeted therapy and immunotherapy, and there may be interactions between these treatments that may affect the results. Therefore, sarcopenia may not be a reliable predictor of PFS in patients receiving triple therapy.

[0082] The results of the present invention show that the overall survival (OS) of patients with sarcopenia is shorter than that of patients without sarcopenia, and similar results were observed between the muscle fatty degeneration group and the non-muscle fatty degeneration group. Multivariate analysis further determined that sarcopenia is a risk factor for overall survival. Sarcopenia and muscle fatty degeneration reflect the decline in skeletal muscle quantity, quality and strength. In patients with hepatocellular carcinoma (HCC), muscle changes result from the complex interaction of multiple factors such as nutritional deficiency, insufficient physical activity, liver dysfunction, hormone / cytokine imbalance and immune disorders, which together lead to muscle degeneration and dysfunction. This degeneration of body composition may in turn have a negative impact on the effect of therapeutic intervention. Therefore, the present invention clearly establishes for the first time the relationship between changes in body composition (such as sarcopenia and muscle fatty degeneration) and the prognosis of triple treatment combined with HAIC, targeted therapy and immunotherapy. The method of the present invention can be well used for the prognostic efficacy evaluation of patients with hepatocellular carcinoma receiving hepatic artery infusion chemotherapy combined with targeted therapy and immunotherapy.

Claims

1. A method for evaluating the prognosis and efficacy of drug treatment for patients with liver cancer based on radiomics, characterized in that: The following steps are involved: (1) Using CT scans, we identified and quantified the body composition of skeletal muscle, subcutaneous fat, visceral fat, and their total cross-sectional area at the L3 level in patients with liver cancer; (2) Calculate the skeletal muscle index and skeletal muscle density, define the sex-specific median skeletal muscle index as the critical value for sarcopenia, and define the sex-specific median skeletal muscle density as the critical value for myosteatosis, and evaluate the progression-free survival and overall survival of patients to predict the prognosis and efficacy of drug treatment in patients with liver cancer.

2. The method according to claim 1, characterized in that The body composition threshold ranges of the L3 level of liver cancer patients described in step (1) are as follows: skeletal muscle is -29HU to 150HU, subcutaneous fat is -190HU to -30HU, and visceral fat is -150HU to -50HU.

3. The method according to claim 1, characterized in that The skeletal muscle density in step (2) is measured by obtaining the average HU value of the L3 level muscle.

4. The method according to claim 1, characterized in that The calculation formula of the skeletal muscle index in step (2) is: skeletal muscle area / height.

5. The method according to claim 1, characterized in that The median cut-off value of skeletal muscle index for male sarcopenia in step (2) is 47.1 cm 2 / m 2 The median cut-off value of skeletal muscle index for female sarcopenia is 38.2 cm 2 / m 2 .

6. The method according to claim 1, characterized in that In step (2), the median critical value of skeletal muscle density for myofatiba degeneration in males is 40.8 HU, and the median critical value of skeletal muscle density for myofatiba degeneration in females is 38.9 HU.

7. The method according to claim 1, characterized in that The progression-free survival and overall survival described in step (2) were estimated using the Kaplan-Meier method and compared by the Log-rank test.

8. The method according to claim 1, characterized in that The liver cancer patient is a hepatocellular carcinoma patient receiving hepatic artery infusion chemotherapy combined with targeted therapy and immunotherapy.

9. The method according to claim 8, characterized in that The targeted therapy is treatment with tyrosine kinase inhibitors, and the immunotherapy is treatment with anti-programmed cell death protein 1 drugs.

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