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

Abstract

Objectives: This study aimed to evaluate the association between different body composition features with prognostic outcomes of intermediate stage hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE).Methods: The areas and density of skeletal muscle area (SM) and adipose tissue [subcutaneous (SAT); visceral (VAT)] were calculated on the pre-TACE CT scans. Overall survival (OS) and progression-free survival (PFS) curves were calculated using the Kaplan–Meier method and compared with log-rank test. The discrimination and performance of body composition features were measured by area under time-dependent receiver operating characteristic (ROC) curve. Univariate and multivariate Cox proportional hazard analyses were applied to identify the association between body composition parameters and outcomes.Results: A significant prolonged OS and PFS was displayed by Kaplan–Meier curve analysis for HCC patients with VAT HU below −89.1 (25.1 months, 95% CI: 18.1–32.1 vs. 17.6 months, 95% CI: 16.3–18.8, p < 0.0001, 15.4 months, 95% CI: 10.6–20.2 vs. 6.6 months, 95% CI: 4.9–8.3, p < 0.0001, respectively). The 1-, 2-, 3-, and 5-year OS area under the curve (AUC) values of the VAT HU were higher than the other body composition parameters. Meanwhile, it is also found that 3-, 6-, 9-, and 12-month PFS AUC values of VAT HU were the highest among all the parameters. Univariate and multivariate Cox-regression analysis suggested a significant association between VAT density and outcomes (OS, HR: 1.015, 95% CI: 1.004–1.025, p = 0.005, PFS, HR: 1.026, 95% CI: 1.016–1.036, p < 0.0001, respectively).Conclusion: The VAT density could provide prognostic prediction value and may be helpful to stratify the intermediate stage HCC patients.

What Is the Role of Body Composition Assessment in HCC Management?

“…High VAT (>−85 HU) radiodensity proved to be associated with both an increased mortality (HR 2.01, 95% CI 1.14–3.54, p = 0.02) and severe adverse events in patients treated with selective internal radiation therapy [ 87 ]. The positive association between a low VAT radiodensity (<−89.1 HU) and tumor response (complete response and partial response) (HR: 1.035, 95% CI: 1.014–1.058, p = 0.001) to TACE was recently reported by Li Q [ 88 ]. Table 4 presents the studies that have evaluated the relation between VAT and HCC outcome published in the last 5 years.…”

Impact of body composition on the prognosis of hepatocellular carcinoma patients treated with transarterial chemoembolization: A systematic review and meta-analysis

“…After removing 52 duplications, and 126 ineligible studies, 14 studies were eventually included in this review. [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] ] The process of study selection is depicted in Fig. 1 .…”

Adipose tissue area is a predictive biomarker for the efficacy of pegylated liposomal doxorubicin in platinum‐refractory/resistant ovarian cancer

“…patients who underwent transarterial chemoembolization, a lower response rate and significantly shorter PFS and OS were reported in patients with higher visceral adipose tissue density than in those with lower density. 15 One possible mechanism by which adipose tissue influences the efficacy of anticancer agents is that it secretes a variety of growth factors, including angiogenic factors. [16][17][18] Angiogenic factors derived from adipose tissue bind and neutralize the antiangiogenic agents, thereby attenuating their effects.…”

“…In breast cancer patients treated with neoadjuvant chemotherapy, patients with high VATA have significantly shorter disease‐free survival than those with low VATA 14 . Additionally, in liver cancer patients who underwent transarterial chemoembolization, a lower response rate and significantly shorter PFS and OS were reported in patients with higher visceral adipose tissue density than in those with lower density 15 …”

“…It has been reported that visceral adipose tissue attenuates tumor response to chemotherapy in breast cancer, 13 and furthermore, visceral adipose tissue has been shown to be a poor prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy 14 . On the contrary, in liver cancer, visceral adipose tissue has been reported to be involved in chemotherapy resistance 15 . One possible mechanism by which adipose tissue is associated with chemotherapy resistance is that adipose tissue secretes various growth factors, including angiogenic factors.…”