Recipient obesity does not affect survival after deceased donor liver transplantation for hepatocellular carcinoma. A national retrospective cohort study in the United States

Pacho

et al. 2019

JCM

Background: Body composition parameters are reported to influence the risk of hepatocellular carcinoma (HCC) recurrence after liver resection, yet data on patients undergoing liver transplantation are scarce. The aim of this study was to evaluate the impact of the amount of abdominal adipose tissue and skeletal muscles on the risk of HCC recurrence after liver transplantation. Methods: This was a retrospective observational study performed on 77 HCC patients after liver transplantation. Subcutaneous fat area (SFA), visceral fat area, psoas muscle area and total skeletal muscle area were assessed on computed tomography on the level of L3 vertebra and divided by square meters of patient height. The primary outcome measure was five-year recurrence-free survival. Results: Recurrence-free survival in the entire cohort was 95.7%, 90.8%, and 86.5% after one, three, and five years post-transplantation, respectively. SFA was significantly associated with the risk of HCC recurrence (p = 0.013), whereas no significant effects were found for visceral fat and skeletal muscle indices. The optimal cut-off for SFA for prediction of recurrence was 71.5 cm2/m2. Patients with SFA < 71.5 cm2/m2 and ≥71.5 cm2/m2 exhibited five-year recurrence-free survival of 96.0% and 55.4%, respectively (p = 0.001). Conclusions: Excessive amount of subcutaneous adipose tissue is a risk factor for HCC recurrence after liver transplantation and may be considered in patient selection process.

Section: Discussionsupporting

confidence: 89%

Impact of Body Composition on the Risk of Hepatocellular Carcinoma Recurrence After Liver Transplantation

Pacho

et al. 2019

JCM

“…Similar mechanisms can be applied to the finding of a survival benefit for obese melanoma patients from the single included study. Several evidences indeed confirmed that a high BMI might be considered a surrogate marker of clinical benefit from immune checkpoint inhibitors for advanced melanoma patients 23 32 34 .…”

Section: Discussionmentioning

confidence: 85%

“…Our literature search yielded 1,892 articles, of which 203 met the inclusion criteria for our overall systematic review of the effect of obesity on cancer outcome 21,22,31,121–130,32,131–140,33,141–150,34,151–160,35,161–170,36,171–180,37,181–190,38,191–200,39,201–210,40,211–220,23,41,221–223,42–50,24,51–60,25,61–70,26,71–80,27,81–90,28,91–100,29,101–110,30,111–120 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Obesity paradox in patients with cancer: A systematic review and meta-analysis of 6,320,365 patients

Petrelli

Cortellini

Indini

et al. 2020

Preprint

BACKGROUND. Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, is associated with a significant increase in risk of many cancers. In last years, various studies suggested that obese cancer patients have better outcomes than non obese patients. This phenomenon, also known as the obesity paradox, is not well understood and presents controversial explanations. We performed a systematic review and metaanalysis to assess the association between obesity and outcome after a diagnosis of cancer. PATIENTS AND METHODS. PubMed, the Cochrane Library, and EMBASE were searched from inception to January 2020, for studies reporting prognosis of patients with obesity and cancer. Risk of death, cancer specific survival (CSS) and progression were pooled to provide an adjusted hazard ratio with a 95% confidence interval (HR 95%CI). The primary outcome of the study refers to overall survival (OS) in obese vs non obese patients with malignancies. Secondary endpoints were CSS and progression or disease free survival (PFS or RFS). RESULTS. Mortality and relapse associated with obesity in patients with cancer were evaluated among n=6,320,365 participants (n=203 studies). Overall, association of obesity and cancer was associated with a reduced OS (HR =1.14, 95% CI: 1.09 1.19; P<.01) and CSS (HR=1.17, 95%CI 1.12 1.23; P<.01). Patients were also at increased risk for relapse (HR=1.13, 95%CI 1.07 1.19; P<.01). Patients with breast, colorectal and uterine tumors were at increased risk of death. Conversely, obese with lung cancer, renal cell carcinoma and melanoma survived longer that non obese. CONCLUSIONS. In many cancer patients, obesity reduces survival and increases the risk of relapse. In lung cancer, renal cell carcinoma and melanoma obesity was protective in terms of outcome. More intensive follow up, adequate dosing of oncological treatments, calories intake restrictions, physical activity and monitoring of obesity related complications are effective measures for reducing mortality in these subjects.

“…[ 16 , 30 , 31 ] Further studies also describe an increased risk of death after transplantation for patients with an increased visceral‐subcutaneous fat tissue ratio, [ 32 ] an increased visceral fat area, [ 33 ] and with myosteatosis. [ 22 , 23 , 34 ] However, there are also contrary data showing that obesity does not affect survival after liver transplantation, [ 35 , 36 ] suggesting that the distinction between different fat compartments might be the clue to reliably predict patients’ outcome in different disease scenarios.…”

Section: Discussionmentioning

confidence: 99%

Body fat composition determines outcomes before and after liver transplantation in patients with cirrhosis

et al. 2022

Cachexia occurs in late stages of liver cirrhosis, and a low-fat mass is potentially associated with poor outcome. This study compared different computed tomography (CT)-derived fat parameters with respect to its prognostic impact on the development of complications and death before and after liver transplantation. Between 2001 and 2014, 612 patients with liver cirrhosis without hepatocellular carcinoma listed for liver transplantation met the inclusion criteria, including abdominal CT scan (±200 days to listing). A total of 109 patients without cirrhosis served as controls. The subcutaneous fat index (SCFI), the paraspinal muscle fat index, and the visceral fat index were assessed at L3/L4 level and normalized to the height (cm 2 /m 2 ). Data were collected and analyzed retrospectively. Low SCFI was associated with a higher rate of ascites and increased C-reactive protein levels (p < 0.001). In addition, multivariate Cox regression analysis adjusting for sex, age, body mass index (BMI), and Model for End-Stage Liver Disease showed that decreasing SCFI was also associated with an increased risk of cirrhosis-related complications (p = 0.003) and death on the transplant wait list (p = 0.013). Increased paraspinal and visceral fat were not only positively correlated with creatinine levels (p < 0.001), BMI, and metabolic comorbidities (all p < 0.001) before transplantation, but also predictive for 1-year mortality after transplantation. Conclusion:The distribution of body fat is a major determinant for complications and outcome in cirrhosis before and after liver transplantation.