High subcutaneous adipose tissue density correlates negatively with survival in patients with hepatocellular carcinoma

Abstract

Background & Aims Body composition parameters have been reported to add information, which can lead to tailored treatment and prognostication for oncological patients. Data for patients with hepatocellular carcinoma (HCC) are scarce. We assessed the association between different body composition parameters and overall survival (OS) in two different newly diagnosed HCC populations. Methods The area (cm2) and density (Hounsfield Units [HU]) of skeletal muscle (SM) and adipose tissue (subcutaneous [SAT], visceral [VAT] and intermuscular [IMAT]) were measured on computed tomography (CT) scans at the level of the third lumbar vertebra (L3) in two cohorts of patients diagnosed in different HCC stages (Bern, Switzerland n = 187 and Newcastle, United Kingdom n = 216). Univariate and multivariate Cox regressions analyses were used to assess the crude and adjusted association of body composition parameters with OS. Results By univariate analysis, in both cohorts, Bern and Newcastle, high SAT density (hazard ratio [HR]: 1.35; 1.12‐1.62, P < .001 and 1.44; 1.27‐1.63, P < .001, respectively) and high VAT density (HR: 1.38; 1.1‐1.72, P = .005 and HR: 1.53; 1.3‐1.81, P < .001, respectively) correlated negatively with survival. After model adjustment for potential baseline confounders (gender, age, diabetes, cirrhosis, MELD score, BCLC stage) in a multivariate analysis, SAT density remained associated with mortality in Bern and Newcastle (Bern: HR: 1.27; 1.04‐1.57, P = .022; Newcastle: HR: 1.23; 1.03‐1.48, P = .022) and VAT remained associated with mortality in Bern (HR: 1.31; 1.05‐1.65, P = .019). Conclusions Based on two HCC cohorts, our data show that high SAT density correlates negatively with OS in HCC patients.

High Visceral Adipose Tissue Density Correlates With Unfavorable Outcomes in Patients With Intermediate-Stage Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

“…Finally, in patients with cancer cachexia, the high CT density of fat tissue, which is determined by fat and lipid could result from the activation of brown adipose tissue ( Beijer et al, 2012 ). Interestingly, a cutoff value of −89.1 HU, which has been demonstrated in the present study, was close to the previous study in HCC patients, with a cutoff value of −88 HU ( von Hessen et al, 2021 ).…”

“…Previous studies showed that both SAT and VAT density were negatively correlated with survival, suggesting that an increased adipose tissue attenuation could be used as a novel non-invasive biomarker for predicting prognosis ( Murphy et al, 2014 ; Rosenquist et al, 2015 ). More recently, Hessen et al suggested that high SAT density correlates negatively with OS in patients with HCC ( von Hessen et al, 2021 ). Our study showed that VAT density was significantly in correlation with tumor response (CR + PR) (odds ratio: 1.035, 95% CI: 1.014–1.058, p = 0.001).…”

“…For standardized analysis of each patient, a cross-sectional enhanced CT images at the third lumbar vertebra (L3) was selected. The areas of skeletal muscle area (SM) and adipose tissue [subcutaneous, (SAT); visceral (VAT)] were measured by using the Slice-O-Matic software (version 5.0; Tomovision, Montreal, Canada), and the calculation was based on the Hounsfield units (HU) thresholds (−29 to 150 HU for SM, −190 to −30 for SAT and −150 to −50 for VAT) ( von Hessen et al, 2021 ). All of the three variables were normalized for the height in m 2 and expressed as indexes (cm 2 /m 2 ).…”

Sarcopenic Obesity in Liver Cirrhosis: Possible Mechanism and Clinical Impact

“…Accumulation of subcutaneous adipose tissue can be an adverse predictor in patients with alcoholic LC [52]. High subcutaneous adipose tissue density and high visceral adipose tissue density on CT significantly correlated negatively with survival in HCC patients [53].…”

Preoperative Assessment of Abdominal Adipose Tissue to Predict Microvascular Invasion in Small Hepatocellular Carcinoma

“…Abdominal VAT and SAT levels better reflect the body's fat distribution and are significantly and positively correlated with obesity. Increased SAT density has been reported to be negatively correlated with survival in HCC patients, 24 and a positive correlation between VAT and HCC MVI has also been reported. 23 However, the aforementioned studies obtained samples from tumors of various sizes.…”