肝细胞癌（HCC）是全球第四大癌症死亡原因，其预后具有高度异质性，不仅与潜在的慢性肝病有关，还与癌症恶病质的严重程度有关。营养因素在影响HCC的预后中起着至关重要的作用。尽管肌肉骨骼失衡一直被认为是 HCC 患者围手术期死亡率的预测因素，但这种情况在临床管理中经常被忽视。骨矿物质密度 (BMD) 是营养状况的标志，可以通过 CT 测量椎骨的像素密度来评估。最近的临床研究表明，BMD 不仅是肝硬化患者发生 HCC 的重要危险因素，而且还可能作为 HCC 患者治疗后结果的独立预后指标。术前腹部CT扫描提供了一种方便且经济有效的BMD测量方法，为HCC患者的预后评估提供了重要帮助。彻底掌握肝骨连接，进行更高质量的研究以及建立 BMD 测量的标准化方法和临界值，可以增强 HCC 的治疗方法。

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer death worldwide and its prognosis is highly heterogeneous, being related not only to underlying chronic liver disease but also to the severity of cancer cachexia. Nutritional factors play a crucial role in influencing the prognosis of HCC. Despite musculoskeletal imbalance being consistently reported as a predictor of perioperative mortality in patients with HCC, this condition is often overlooked in clinical management. Bone mineral density (BMD), which serves as a marker of nutritional status, can be assessed through CT by measuring the pixel density of the vertebral bone. Recent clinical studies have indicated that BMD serves not only as a significant risk factor for development of HCC in cirrhotic patients but also potentially functions as an independent prognostic indicator for post-treatment outcomes in patients with HCC. Preoperative abdominal CT scans provide a convenient and cost-effective method to measure BMD, offering significant assistance in prognostic evaluation of patients with HCC. A thorough grasp of the liver-bone connection, along with the conduct of higher-quality studies and the establishment of standardized methods and cutoff values for BMD measurement, could enhance approaches to manage HCC.