Low muscle mass (LMM) and low muscle density (LMD) are increasingly recognized as prognostic factors for survival in different malignancies. This study determined the association of LMM and LMD with survival in DLBCL (diffuse large B-cell lymphoma) patients. CT-based measurement of muscle was performed in 164 DLBCL patients prior to chemo-immunotherapy. Z-scores adjusted for gender, age, and body mass index were derived from a healthy reference population. LMM or LMD were defined as a Z-score below À1 and were related to OS and PFS. The coexistence of both LMM and LMD was observed in 13% of the DLBCL patients and was significantly associated with shorter OS and PFS. Also, these patients more often did not complete the planned treatment. The combination of LMM and LMD is an independent prognostic factor for survival in DLBCL patients. This may guide clinical decision-making in patients with suspected insufficient performance to benefit from chemo-immunotherapy in standard doses. KEY POINTS Patients with DLBCL have low muscle mass (LMM) and low muscle density (LMD) compared to healthy counterparts. The combination of LMM and LMD is a negative prognostic factor for survival, independent of comorbidities and unfavorable lymphoma characteristics.

Background: It remains challenging to predict outcomes in patients with advanced HCC. Small and non-European studies have associated low muscle mass (sarcopenia) and visceral adiposity with impaired survival and increased treatment toxicity. However, large studies in European patients are lacking. Methods: A retrospective analysis was performed in HCC patients treated with sorafenib at two tertiary referral centers between 2007-2016. Muscle mass and density and adipose tissue areas were measured at baseline by computed tomography (CT) at the third lumbar vertebra (L3) level. Sarcopenia and low muscle density were defined using published cutoff points. Body composition parameters were correlated with overall survival (OS), time-toprogression (TTP), response rate, and toxicity. Results: In total, 278 patients were included (79% male, median age 66) with a median OS of 9.5 (95%CI;8.1-11.0) months. At baseline, 52% had sarcopenia and 41% had low muscle density. Sarcopenia showed an independent association with TTP (HR 1.36;95%CI 1.03-1.77;p=0.04), whereas low total adipose tissue index (TATI) was associated with reduced OS. Combined presence of sarcopenia and low total adipose tissue index (TATI) was associated with reduced treatment duration (16 vs 11 weeks, p=0.029) and independently associated with poorer OS (HR 1.68;95%CI 1.24-2.27;p=0.001). None of the body composition parameters was independently associated with response rate or treatment toxicity. Conclusion: In European patients with HCC treated with sorafenib, low TATI and presence of sarcopenia are independent prognostic factors of poorer OS and TTP respectively. Combined presence impairs survival to a greater extent. CT-assessed body composition provided prognostic information prior to sorafenib treatment.

Objective: To develop a risk score to predict serious postoperative complications after hepatic resection in noncirrhotic patients. Methods: Multivariate logistic regression analysis was used to develop risk score to predict severe complications (Clavien-Dindo class, IIIeV) after 502 liver resections performed in non-cirrhotic patients at a single tertiary care center (2005e2015). Model calibration and discrimination were tested using HosmereLemeshow test and C-statistics respectively. Results: The rate of serious complications was 22.8% (Grade III, 69 (13.3%); Grade IV, 48 (9.5%)) while mortality was (3.8%). Multivariate predictors of postoperative complications included sex (male; odds ratio (OR) 1.42), hepatitis C (OR 3.22), diabetes (OR 1.45), hypertension (OR 1.67), ECOG performance status >1 (OR 2.15), albumin (<3.5 mg/dl; (OR 3.09)), extrahepatic reconstruction (biliary or vascular OR 12.0; bowel resection OR 1.85; other procedures OR 1.43), and extent of liver resection (two-segment OR 1.38; three-segment OR 1.85; foursegment OR 3.95; five-segment OR 6.27). The risk score accurately predicted postoperative serious complications (discrimination (C-statistics 0.79) and calibration (p = 0.28)) and the risk score categories were associated with serious morbidity (category 0e2 6%; 3e4 13.7%; 5e 6 23%; 7 53%, P < 0.001), readmission rate (category 0e 2 6%; 3e4 11.5%; 5e6 18.3%; 7 35%, P < 0.001) and mean length of hospital stay (category 0e2 4.2 days; 3e4 5.5 days; 5e6 6.1 days; 7 9.8 days, P<0.001). Conclusion:The risk score had high discriminative ability to predict serious postoperative complications in noncirrhotic patients undergoing liver resection. These data will assist surgeons, patients and their families in making informed decision when hepatic resection is being contemplated.

Background: Distal cholangiocarcinoma has a poor prognosis. Published cohorts focusing on distal cholangiocarcinoma, especially from Western countries, are lacking. This study investigated treatment, outcome and predictors for survival in a nationwide cohort of patients with distal cholangiocarcinoma. Methods: A population-based cohort derived from the Netherlands Cancer Registry (NCR) was studied. Patients with pathologically confirmed distal cholangiocarcinoma, resected (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) and non-resected (2009-2015), were included. Survival was analyzed using Kaplan Meier methods and multivariable Cox analysis using backward selection. Results: A total of 794 patients was identified; 513 resected patients and 321 non-resected patients. Of the resected patients (7.8%) received (neo-)adjuvant treatment. Of 321 non-resected patients, 147 (45.8%) presented with M1 disease and 63 (19.6%) received palliative chemotherapy. Median overall survival for resected, non-resected M0, and non-resected M1 disease was 23 months (95% CI 21-26), 6 months (95% CI 5-8) and 4 months (95% CI 4-5) (p< 0.001), respectively. In multivariable analysis, T3/T4 stage (p=0.006), higher lymph node ratio (p< 0.001), poor differentiation (p=0.001) and R1 resection (p=0.002) were negative prognostic factors in resected patients. In nonresected patients, increasing age (p=0.007), lymph node metastases (p=0.013), distant metastases (p< 0.001), no surgical exploration (p=0.011) and no palliative chemotherapy (p< 0.001) predicted worse survival. Discussion: This nationwide, Western study includes the largest population with all stages of distal cholangiocarcinoma. The study identified predictors for survival in both the resected and non-resected population which can be useful to stratify future trials with (neo-) adjuvant or palliative treatment.

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