Low bone mineral density is a prognostic factor for elderly patients with HCC undergoing TACE: results from a multicenter study

Abstract

Objectives Low bone mineral density (BMD) was recently identified as a novel risk factor for patients with hepatocellular carcinoma (HCC). In this multicenter study, we aimed to validate the role of BMD as a prognostic factor for patients with HCC undergoing transarterial chemoembolization (TACE). Methods This retrospective multicenter trial included 908 treatment-naïve patients with HCC who were undergoing TACE as a first-line treatment, at six tertiary care centers, between 2010 and 2020. BMD was assessed by measuring the mean Hounsfield units (HUs) in the midvertebral core of the 11th thoracic vertebra, on contrast-enhanced computer tomography performed before treatment. We assessed the influence of BMD on median overall survival (OS) and performed multivariate analysis including established estimates for survival. Results The median BMD was 145 HU (IQR, 115–175 HU). Patients with a high BMD (≥ 114 HU) had a median OS of 22.2 months, while patients with a low BMD (< 114 HU) had a lower median OS of only 16.2 months (p < .001). Besides albumin, bilirubin, tumor number, and tumor diameter, BMD remained an independent prognostic factor in multivariate analysis. Conclusions BMD is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. The integration of BMD into novel scoring systems could potentially improve survival prediction and clinical decision-making. Key Points • Bone mineral density can be easily assessed in routinely acquired pre-interventional computed tomography scans. • Bone mineral density is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. • Thus, bone mineral density is a novel imaging biomarker for prognosis prediction in elderly patients with HCC undergoing TACE.

Impact of body composition on the prognosis of hepatocellular carcinoma patients treated with transarterial chemoembolization: A systematic review and meta-analysis

“…After removing 52 duplications, and 126 ineligible studies, 14 studies were eventually included in this review. [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] ] The process of study selection is depicted in Fig. 1 .…”

“…All were retrospective except for one prospective study [ 27 ]; two were multi-center studies. [ 23 , 32 ] A total of 3631 patients were included, with a patient population ranging from 56 to 908 (median: 186). The average age ranged from 58 to 82; one study focused on octogenarians [ 24 ] and another on patients aged ≥65.…”

“…Five studies applied techniques of both conventional TACE and drug-eluting bead TACE [ [24] , [25] , [26] , 29 , 34 ], six studies focused on conventional TACE [ 28 , 30 , 31 , 33 , 35 , 36 ], while specific techniques were not listed in three studies. [ 23 , 27 , 32 ] Seven studies reported that repeated TACE was carried out once viable residual tumors were detected during follow-up examinations. [ 24 , 25 , 28 , 30 , 31 , 33 , 36 ] Detailed information is shown in Table 1 .…”

“…These methods are more widely available and easy-to-use. However, they involve additional exam and costs [ 32 ]. Furthermore, they cannot provide the distribution information, which is of clinical importance to evaluate ectopic fat, for example liver steatosis, or myosteatosis [ 39 ].…”