Use of computed tomography-derived body composition to determine the prognosis of patients with primary liver cancer treated with immune checkpoint inhibitors: a retrospective cohort study

Abstract

Background Immune checkpoint inhibitors (ICIs) have been used to successfully treat primary liver cancer (PLC); however, identifying modifiable patient factors associated with therapeutic benefits is challenging. Obesity is known to be associated with increased survival after ICI treatment; however, the relationship between body composition (muscle, fat) and outcomes is unclear. This study aimed to evaluate the association between sarcopenia and CT-derived fat content and the prognosis of ICIs for the treatment of PLC. Methods In this retrospective cohort study of 172 patients with PLC, we measured the skeletal muscle index (SMI), skeletal muscle density, visceral adipose tissue index, subcutaneous adipose tissue index, total adipose tissue index (TATI), and visceral-to-subcutaneous adipose tissue area ratio using CT. In addition, we analyzed the impact of body composition on the prognosis of the patients. Multivariate Cox regression analysis was used to screen for influencing factors. Results Among the seven body composition components, low SMI (sarcopenia) and low TATI were significantly associated with poor clinical outcomes. Multivariate analysis revealed that sarcopenia (hazard ratio [HR], 5.39; 95% confidence interval [CI], 1.74–16.74; p = 0.004) was a significant predictor of overall survival (OS). Kaplan–Meier curves showed that sarcopenia and TATI were significant predictors of OS. Body mass index was not associated with survival outcomes. Conclusions Sarcopenia and fat tissue content appear to be independently associated with reduced survival rates in patients with PLC treated with ICIs.

Predictive Value of the Hepatic Immune Predictive Index for Patients with Primary Liver Cancer Treated with Immune Checkpoint Inhibitors

“…NLR as a factor for recurrence or survival in HCC has been evaluated with various treatments, including surgical resection, radiofrequency ablation, liver transplantation, and transhepatic arterial chemoembolization [22-26]. Furthermore, Rich et al [23] have found that the mortality was significantly increased in patients with a baseline NLR <5 than in those with baseline NLR ≥5.…”

Impact of Patient Characteristics on the Outcomes of Patients with Gastrointestinal Cancers Treated with Immune Checkpoint Inhibitors

“…Sarcopenia has been repeatedly associated with poor OS in cancer patients [52,54,61,62], which extends to ICI treatment outcomes. Cachexic gastric cancer patients previously treated with chemotherapy who received nivolumab had a significantly worse median OS (2.3 vs. 6.6 months, HR 2.65, 95% CI [1.28-5.49]) and time to treatment failure (1.8 vs. 2.6 months, HR 2.65, 95% CI [1.28-5.49]) compared to non-cachectic patients [61].…”

“…Patients with a BMI of ≥25 had improved objective response rates (41.3% vs. 20.9%, p < 0.0001), a median PFS (11.7 vs. 3.7 months, HR 0.46, 95% CI [0.39-0.54]), and a median OS (26.6 vs. 6.6 months, HR 0.33, 95% CI [0.28-0.41]) compared to those with a BMI of <25 [53]. Other measures of adipose tissue, including the visceral adipose tissue index based on baseline CT imaging, have shown similarly positive associations in GI cancer patients [54].…”

Metabolic and histomorphological changes of adipose tissue in cachexia

“…Moreover, additional evidences on the role of changes of WAT in cancer have been obtained by retrospective studies conducted among gastrointestinal cancers and in hematological diseases [35–39,40 ▪ ,41–43]. Also, a systematic review including studies on COPD showed a link between changes in adiposity and cardiovascular diseases [44].…”