Abstract
Hepatocellular carcinoma (HCC) constitutes the fourth leading cause of cancer-related mortality. Various factors, such as tumor size, tumor multiplicity, and liver function, have been linked to the prognosis of HCC. The aim of this study was to explore the prognostic significance of muscle, subcutaneous and visceral adipose tissue (VAT) mass, and radiodensity, in a cohort of 101 HCC patients treated with selective internal radiation therapy (SIRT). Muscle and adipose tissue cross sectional area (cm2/m2) and radiodensity, reported as the Hounsfield Unit (HU), were determined using pre-SIRT computed tomography images. Cox proportional hazard models and exact logistic regression were conducted to assess associations between body composition and adverse outcomes. Majority of the patients were male (88%) with a mean VAT radiodensity of −85 ± 9 HU. VAT radiodensity was independently associated with mortality (HR 1.05; 95% CI: 1.01–1.08; p = 0.01), after adjusting for cirrhosis etiology, Barcelona Clinic Liver Cancer stage, previous HCC treatment, and portal hypertension markers. Patients with a high VAT radiodensity of ≥–85 HU had a two times higher risk of mortality (HR 2.01, 95% CI 1.14–3.54, p = 0.02), compared to their counterpart. Clinical features of portal hypertension were more prevalent in patients with high VAT radiodensity. High VAT radiodensity was associated with severe adverse events after adjusting for confounding factors. High VAT radiodensity is independently associated with both increased mortality and severe adverse events in patients treated with SIRT. VAT radiodensity measurement might serve as an objective approach to identify patients who will experience the most benefit from SIRT.
Highlights
Hepatocellular carcinoma (HCC) is the main form of primary liver cancer and constitutes the fourth leading cause of cancer-related mortality worldwide [1]
Association between visceral adipose tissue (VAT) radiodensity but not the cross sectional area, with adverse outcomes in HCC patients treated with selective internal radiation therapy (SIRT), suggests the prognostic significance of adipocyte remodeling with diminished lipid stores rather than the adipose tissue mass, in predicting the worse outcomes
Post-SIRT survival is influenced by various factors related to liver function and tumor burden
Summary
Hepatocellular carcinoma (HCC) is the main form of primary liver cancer and constitutes the fourth leading cause of cancer-related mortality worldwide [1]. (90Y-SIRT) is the most popular radioembolization technique [3] to reduce tumor burden, and improve the survival and quality of life of HCC patients [4]. Various factors, such as size and number of tumors, liver function, and body composition features have been linked to the prognosis of patients with HCC [2,5]. With regard to other predictive tests, the albumin–bilirubin (ALBI) grade demonstrates superiority to Child–Pugh in predicting the survival of HCC patients treated with radioembolization [6]. ALBI alone does not include other prognostic factors such as patient performance status and tumor burden.
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