Physical activity improves overall survival in patients with hepatocellular carcinoma

Introduction: Physical activity improves survival in various cancers, but its impact in patients with hepatocellular carcinoma (HCC) remains unexplored. We aimed to investigate the association between initiating moderate-to-vigorous physical activity (MVPA) after HCC diagnosis and overall survival among previously inactive patients. Methods: This retrospective cohort study used Korean National Health Insurance Service data from 21,035 adults diagnosed with HCC between 2010 and 2023 who were physically inactive before diagnosis and completed biennial health examinations pre- and post-diagnosis. MVPA initiation was assessed through standardized questionnaires. Primary outcome was all-cause mortality; secondary outcomes were cancer-specific and non-cancer-specific mortality. Cox models estimated adjusted hazard ratios and 95% confidence intervals. Results: Among 21,035 patients (mean age 62.1 years; 78.1% male), 5,639 (26.8%) initiated MVPA and 15,396 (73.2%) remained inactive. During follow-up, 7,122 deaths occurred. The 12-year cumulative mortality was lower with MVPA initiation versus remaining inactive (53.9% vs 61.2%; adjusted HR, 0.86; 95% CI, 0.82-0.92). Consistent associations were observed in patients receiving curative treatment (HR, 0.86; 95% CI, 0.78-0.95), those without curative treatment (HR, 0.87; 95% CI, 0.81-0.93), patients with viral HCC (HR, 0.87; 95% CI, 0.81-0.93), non-viral HCC (HR, 0.86; 95% CI, 0.77-0.96), cirrhotic patients (HR, 0.86; 95% CI, 0.80-0.93), and non-cirrhotic patients (HR, 0.88; 95% CI, 0.81-0.96). Propensity score–matched analysis confirmed these findings (HR, 0.87; 95% CI, 0.82-0.92). Conclusions: Among physically inactive adults with HCC, initiating MVPA after diagnosis was associated with lower mortality compared with remaining inactive, suggesting that promoting physical activity should be considered in comprehensive HCC care.