Preoperative Visceral Adiposity and Muscularity Predict Poor Outcomes after Hepatectomy for Hepatocellular Carcinoma

Abstract

Objective: Visceral adiposity, defined as a high visceral-to-subcutaneous adipose tissue area ratio (VSR), has been shown to be associated with poor outcomes in several cancers. However, in the surgical field, the significance of visceral adiposity remains controversial. The present study investigated the impact of visceral adiposity as well as sarcopenic factors (low muscularity) on outcomes in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Patients and Methods: This retrospective study analyzed data from 606 patients undergoing hepatectomy for HCC at our institution between April 2005 and March 2016. Using preoperative plain computed tomography imaging at the level of the third lumbar vertebra, visceral adiposity, skeletal muscle mass, and muscle quality were evaluated by the VSR, skeletal muscle mass index (SMI), and intramuscular adipose tissue content (IMAC), respectively. The impact of these parameters on outcomes after hepatectomy for HCC was analyzed. Results: The overall survival rate was significantly lower among patients with a high VSR (p < 0.001) than among patients with a normal VSR. Similarly, the recurrence-free survival rate was significantly lower among patients with a high VSR (p = 0.016). A high VSR, low SMI, and high IMAC contributed to an increased risk of death (p < 0.001) and HCC recurrence (p < 0.001) in an additive manner. Multivariate analysis showed that not only preoperative low muscularity but also visceral adiposity was a significant risk factor for mortality (hazard ratio [HR] = 1.566, p < 0.001) and HCC recurrence (HR = 1.329, p = 0.020) after hepatectomy for HCC. Conclusions: Preoperative visceral adiposity, as well as low muscularity, was closely related to poor outcomes after hepatectomy for HCC. It is crucial to establish a new strategy including perioperative nutritional interventions with rehabilitation for better outcomes after hepatectomy for HCC.

Phenotypes of Sarcopenic Obesity: Exploring the Effects on Peri-Muscular Fat, the Obesity Paradox, Hormone-Related Responses and the Clinical Implications

“…Such findings reinforce the proposed mechanism related to the role of proinflammatory cytokines secreted by metabolically active adipocytes or adipose tissues in the development and progression of sarcopenic obesity [11]. Moreover, during the aging process, the shift of adipose tissue from subcutaneous to visceral adipose sites along with skeletal muscle atrophy leads to an imbalance between proinflammatory adipokines and anti-inflammatory myokines [14]. This unfavorable adipokine/cytokine profile represents a common mechanism for sarcopenia, obesity and immune senescence in elderly populations [15].…”

Prognostic value of sarcopenia in patients with colorectal liver metastases undergoing hepatic resection

“…Although these results were discrepant with other findings 15,26 , our data were consistent with a recent report showing that age and obesity were found to be independently associated with sarcopenia in patients undergoing liver transplant evaluation 27 . Previous studies have reported that patients with sarcopenic obesity had worse survival in hepatocellular carcinoma receiving hepatectomy or after living donor liver transplantation [28][29][30][31] . While our data in accordance with a recent study showed that sarcopenicobesity was not a prognostic factor in patientsundergoingliver resection for CRLM 32 .…”

Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments

“…The odds ratio (OR) reported for post hepatectomy liver failure (PHLF) prediction by sarcopenia was 2.44 (95% CI 1.20–4.99, p = 0.012). More recent studies [ 24 , 25 ] showed the role of sarcopenic obesity on prognosis after hepatectomy; in the study by Kobayashi et al [ 25 ] patients were classified on the basis of body composition into four groups as non-sarcopenic non-obesity (39%), non-sarcopenic obesity (47%), sarcopenic non- obesity (7%) and sarcopenic obesity (7%). The OS and the recurrence-free survival rates after hepatectomy for HCC were significantly lower in the sarcopenic obesity group than in the non-sarcopenic non-obese group ( p = 0.002 and p = 0.003, respectively).…”