Association of Exercise Tolerance with Survival in Patients with Hepatocellular Carcinoma Receiving Locoregional Therapy

Objectives: Functional exercise capacity is impaired in patients with chronic diseases or malignancies. This study aimed to investigate the association between exercise tolerance and the prognosis of patients with hepatocellular carcinoma receiving locoregional therapy. Methods: This single-center prospective study enrolled 41 consecutive patients with hepatocellular carcinoma who had a Barthel index of 100 and received locoregional therapy. Baseline exercise tolerance, physical function, and body composition were measured. Factors associated with mortality were assessed using a Cox proportional hazards model. Recurrence-free and overall survival rates were evaluated using the Kaplan-Meier analysis and log-rank test. Results: Of the 41 patients, 16 were shown to have exercise intolerance through the 6-min walk test. None of the baseline laboratory data, physical function, body composition, or sarcopenia comorbidity showed significant differences between exercise-tolerant and exercise-intolerant patients. During a median follow-up period of 31 months, 8 patients died. The multivariate Cox proportional hazards model identified the baseline albumin-bilirubin score and exercise intolerance as independent predictors of mortality. Kaplan-Meier analyses showed that the overall, but not recurrence-free, survival rate was significantly lower in patients with exercise intolerance than in those with exercise tolerance. Conclusions: Exercise intolerance is associated with lower survival in patients with hepatocellular carcinoma receiving locoregional therapy. In particular, patients with albumin-bilirubin grade 2 and exercise intolerance may be at high risk of poor prognosis after locoregional therapy.