Fat density is a novel prognostic marker in patients with esophageal cancer

Abstract

Background & aims: While long-term obesity is a well-known risk factor for esophageal adenocarcinoma (ADC), recent weight loss represents a significant concern in esophageal cancer (EC), in relation with dysphagia and disease aggressiveness. These phenomenons may diversely impact the adipose tissue density, suggested in other cancer settings as an important prognostic biomarker. The analysis of body mass composition (BMC) parameters, including adipose tissue attenuation is studied here in a population of EC operated with curative intent. Methods: BMC was retrospectively evaluated on Computed-Tomography (CT)-scan images from fluorodeoxyglucose (FDG)-positron-emitting (PET)/CT scans performed as a diagnostic procedure in a cohort of 145 EC patients operated with curative intent The mean subcutaneous (SFD) and visceral fat (VFD) density along with the index (area/height 2) (SF index (SFI), VF index (VFI)) were assessed on two adjacent slides at the third lumbar vertebra level by two independent investigators. Overall survival (OS) was calculated from the date of the baseline FDG-PET/CT scan. Results: Inter-observer correlations are excellent for all BMC parameters (r ¼ 0.94e0.99). As expected, weight loss is associated with worse outcome. We show that low SFD (HR 0.5 (95% CI: 0.3e0.7), p < 0.001) and low VFD (HR 0.6 (95% CI: 0.4e0.9), p ¼ 0.04) at diagnosis are associated with better OS. In contrast, body mass index (BMI) fails to show any relevance in predicting survival. Conclusions: Adipose tissue density is an important prognostic factor in EC.

Abdominal Fat Characteristics and Mortality in Rectal Cancer: A Retrospective Study

“…In general, our finding is in line with previous studies investigating several cancers (i.e., oesophagus, pancreas, liver, blood, soft tissue and head-and-neck) [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Of those, only one study was conducted on a population (i.e., CRC) similar to that investigated in our study [ 22 ], and examined the adipose tissue radiodensity prognostic utility, showing a linear association between VAT and SAT density and all-cause mortality in a large cohort of over 3000 patients.…”

“…The underlying mechanism behind this relationship is still unclear and needs clarification. Indeed, lower fat tissue density may reflect larger adipocytes filled by large lipid droplets (i.e., a potentially worst fat in terms of cardiometabolic risk) [ 27 ], while higher fat density may indicate a lower lipid content of adipocytes due to shrinkage and fibrosis (possibly following patient weight loss, a known poor prognostic factor at cancer diagnosis) [ 12 ] or inflammation of adipose tissue [ 24 ]. Moreover, since inflammation was found to be associated both with increased adipose tissue density and with reduced OS in patients with cancer cachexia [ 28 ], we cannot exclude the fact that inflammation can be a common denominator in this scenario.…”

“…Over the past few years, besides the quantities of fat and muscle, there has been a focus on the study of the radiodensity of skeletal muscle mass and adipose tissue measured by CT as new prognostic biomarkers of oncological outcomes. For instance, a high adipose tissue radiodensity has been found to be associated with lower survival rates among patients with oesophageal cancer [ 12 ], pancreatic adenocarcinoma [ 13 ], hepatocellular carcinoma [ 14 ], head-and-neck cancer [ 15 ], extremity sarcoma [ 16 ] and multiple myeloma [ 17 ], as well as with other poorer outcomes such as increased post-surgical infection and tumour recurrence in patients with soft tissue sarcoma [ 18 ].…”