Body Composition Predicts Survival in Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Abstract

PurposeThe prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is often uncertain. We aimed to utilize analytic morphomics, a high-throughput imaging analysis, to assess if body composition is predictive of post-TACE survival.Materials and MethodsWe included patients from a single center (Ann Arbor VA)who had TACE as the primary treatment forHCC and had a pre-treatment computed tomography scans. Univariate analysis and multivariate conditional inference tree analysis were utilized to identify the morphomic characteristics predictive of 1-year survival. Results were validated in an external cohort(University of MichiganHealth System) ofHCC patientswho underwent TACE as their primary treatment.ResultsIn the 75 patients in the derivation cohort, median survival was 439 (interquartile range, 377 to 685) days from receipt of TACE, with 1-year survival of 61%. Visceral fat density (VFD) was the only morphomic factor predictive of overall and 1-year survival (p < 0.001). Patients with VFD above the 56th percentile had a 1-year survival of 39% versus 78% for those below the 56th percentile. VFD also correlated with 1-year survival in the external validation cohort (44% vs. 72%, p < 0.001). In a secondary analysis, patients with higher VFD were significantly more likely to experience hepatic decompensation after TACE (p < 0.001).ConclusionVFD served as an objective predictor of mortality in patients undergoing TACE, possibly through its ability to predict hepatic decompensation. VFD may serve as a radiographic biomarker in predicting TACE outcomes.

Fat Accumulation, Liver Fibrosis, and Metabolic Abnormalities in Chinese Patients With Moderate/Severe Versus Mild Hepatic Steatosis

“…In this study, we used CT scan and analytic morphomics, which allow us to provide precise and detailed measurements of fat in liver, visceral, subcutaneous, and other body compartments such as muscles. We have previously shown that analytic morphomics measurements are accurate predictors of new‐onset diabetes and survival after liver transplantation, and provide important information about clinical outcomes in patients with liver disease …”

“…We have previously shown that analytic morphomics measurements are accurate predictors of new-onset diabetes and survival after liver transplantation, (24,27) and provide important information about clinical outcomes in patients with liver disease. (25,(41)(42)(43) Several studies have shown that ectopic fat deposition in the liver, skeletal muscle, and heart is a key determinant of insulin resistance. Adipose tissue is not only a site for storage of lipids, but it also secretes various hormones and cytokines involved in regulating glucose and lipid metabolism and energy homeostasis.…”

Review article: prognostic significance of body composition abnormalities in patients with cirrhosis

“…Visceral adipose tissues radiodensity above the 56thpercentile was considered to be high and was discriminative of post‐transarterial chemoembolisation mortality. An age‐ and sex‐matched population of over 6000 patients who underwent CT scans mainly for trauma, served as a reference population 114 . Using a similar reference population, subcutaneous adipose tissue radiodensity above the median of 68.7 HU was defined as high subcutaneous adipose tissue radiodensity in 274 patients with cirrhosis who were followed prospectively for ≤5 years after a CT scan from the level of 12th thoracic vertebra 115 …”

Limitations of the barcelona clinic liver cancer staging system with a focus on transarterial chemoembolization as a key modality for treatment of hepatocellular carcinoma

“…This may be reflective of the intrinsic qualitative nature of the scoring system. In an attempt to better characterize the patient population, we have used a novel methodology (analytic morphomics) to assess patient characteristics by using quantitative image analysis of the readily available computed tomography imaging studies . Analytic morphomics is an image‐processing technique that assesses body composition measures such as body dimensions, visceral fat, and muscle mass, and links them to clinical outcomes .…”

“…In an attempt to better characterize the patient population, we have used a novel methodology (analytic morphomics) to assess patient characteristics by using quantitative image analysis of the readily available computed tomography imaging studies. 13,14 Analytic morphomics is an image-processing technique that assesses body composition measures such as body dimensions, visceral fat, and muscle mass, and 13 This provides a more objective manner of assessing functional status. Our results demonstrated that in comparison with the BCLC staging system, a model that included analytic morphomics provided a highly accurate prognosis in the nonsurgical population.…”