Osteopenia is associated with inferior survival in patients undergoing partial hepatectomy for hepatocellular carcinoma

Abstract

Osteopenia is known to be associated with clinical frailty which is linked to inferior outcomes in various clinical scenarios. However, the exact prognostic value of osteopenia in patients undergoing curative intent-surgery for hepatocellular carcinoma (HCC) is not completely understood. This retrospective study was conducted in a cohort of 151 patients who underwent partial hepatectomy for HCC in curative intent at a German university medical center (05/2008–12/2019). Preoperative computed tomography-based segmentation was used to assess osteopenia, and the prognostic impact of pathological changes in bone mineral density (BMD) on perioperative morbidity, mortality, and long-term oncological outcome was analyzed. Five-year overall survival of osteopenic patients was significantly worse compared to those with normal BMD (29% vs. 65%, p = 0.014). In line with this, the probability of disease-free survival at 5 years was significantly worse for patients with osteopenia (21% vs. 64%, p = 0.005). In our multivariable model, osteopenia was confirmed as an independent risk-factor for inferior overall survival (Hazard-ratio 7.743, p = 0.002). Concerning perioperative complications, osteopenic patients performed slightly worse, even though no statistical difference was detected (Clavien-Dindo ≥ 3b; 21% vs. 9%, p = 0.139). The present study confirms osteopenia as an independent risk-factor for inferior survival in patients undergoing partial hepatectomy for HCC in a European cohort. Further studies are warranted to validate these findings.

Preoperative Bone Loss Predicts Decreased Survival Associated with Microvascular Invasion after Resection of Hepatocellular Carcinoma

“…The association between age and BMD in females is stronger than in males. Various patient-related factors are recognized to influence BMD, including gender, age, race, and menopausal status [ 8 ]. In some reports, osteopenia in females was not associated with OS [ 7 , 8 ], possibly because BMD in female patients is so strongly affected by age that its effect on postoperative survival may be diminished [ 7 ].…”

“…Various patient-related factors are recognized to influence BMD, including gender, age, race, and menopausal status [ 8 ]. In some reports, osteopenia in females was not associated with OS [ 7 , 8 ], possibly because BMD in female patients is so strongly affected by age that its effect on postoperative survival may be diminished [ 7 ]. However, in the present study, osteopenia in females was significantly associated with both OS and RFS.…”

“…One possibility for this discrepancy may be related to differences in the operative techniques used for resection. The present study included anatomic liver resections not included in previous studies [ 7 , 8 ]. Other possibilities for the observed discrepancies may be related to race, distribution of age, and the cutoff value used to define osteopenia.…”

“…Osteopenia, in which bone mineral density (BMD) becomes lower than normal but not as severely low as in osteoporosis, has recently received attention for its association with hepatobiliary cancer [ 6 , 7 , 8 ]. Dual-energy X-ray absorptiometry (DXA) is the gold standard for evaluating BMD, but computed tomography (CT) scan-based attenuation values are widely used for the preoperative staging of hepatocellular carcinoma patients and are increasingly used to characterize BMD [ 9 ].…”

A Nomogram Combining Body Composition Analysis and Clinical Factors for Predicting the Prognosis of Patients with Resectable Rectal Cancer

“…Total fat area (TFA), subcutaneous fat area (SFA), and visceral fat area (VFA) at the lumbar 3 vertebral body level (L3) were automatically obtained using the "auto snake" of the "tissue composition" function in QCT Pro software. And manually divide the total area of all skeletal muscles (psoas major, erector spinae, psoas quadratus, transversus abdominis, external oblique, and internal oblique) at the same level [9] , namely L3 skeletal muscle area (L3 SMA). The above measurement process was performed by two radiologists with more than 5 years of diagnostic experience using a double-blind method (Figure 2).…”