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

다국어 초록 (Multilingual Abstract)

Purpose The 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 Methods We included patients from a single center (Ann Arbor VA) who had TACE as the primary treatment for HCC 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 Michigan Health System) of HCC patients who underwent TACE as their primary treatment.
Results In 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).
Conclusion VFD 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.

참고문헌 (Reference)

1 Krishnamurthy V, "Use of analytic morphomics of liver, spleen, and body composition to identify patients at risk for cirrhosis" 13 : 360-368, 2015

2 Llovet JM, "Prognosis of hepatocellular carcinoma: the BCLC staging classification" 19 : 329-338, 1999

3 Barman PM, "Predictors of mortality in patients with hepatocellular carcinoma undergoing transarterial chemoembolization" 59 : 2821-2825, 2014

4 Kohla MA, "Predictors of hepatic decompensation after TACE for hepatocellular carcinoma" 2 : e000032-, 2015

5 Zhang P, "Prediction of thoracic injury severity in frontal impacts by selected anatomical morphomic variables through model-averaged logistic regression approach" 60 : 172-180, 2013

6 Peterson MD, "Muscle weakness is associated with diabetes in older Mexicans: the Mexican health and aging study" 17 : 933-938, 2016

7 Kelly CM, "Moving beyond Karnofsky and ECOG performance status assessments with new technologies" 2016 : 6186543-, 2016

8 Hui Y, "Meta-analysis of doxorubicin-eluting beads via transcatheter arterial chemoembolization in the treatment of unresectable hepatocellular carcinoma" 62 : 1002-1006, 2015

9 Bruix J, "Management of hepatocellular carcinoma: an update" 53 : 1020-1022, 2011

10 Barman PM, "Limitations of the Barcelona Clinic Liver Cancer Staging System with a focus on transarterial chemoembolization as a key modality for treatment of hepatocellular carcinoma" 7 : 32-35, 2016

11 Petrick JL, "Future of hepatocellular carcinoma incidence in the United States forecast through 2030" 34 : 1787-1794, 2016

12 Singal AG, "Failure rates in the hepatocellular carcinoma surveillance process" 5 : 1124-1130, 2012

13 Kirstein MM, "Experience from a real-life cohort: outcome of 606 patients with hepatocellular carcinoma following transarterial chemoembolization" 52 : 116-124, 2017

14 Yopp AC, "Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome" 21 : 1287-1295, 2014

15 Jeon HJ, "Discrepancies in performance status scores as determined by cancer patients and oncologists: are they influenced by depression?" 29 : 555-561, 2007

16 Patel N, "Diagnostic delays are common among patients wtih hepatocellular carcinoma" 13 : 543-549, 2015

17 Huhdanpaa H, "Development of a quantitative method for the diagnosis of cirrhosis" 46 : 1468-1477, 2011

18 Frenette CT, "Conventional TACE and drug-eluting bead TACE as locoregional therapy before orthotopic liver transplantation: comparison of explant pathologic response" 98 : 781-787, 2014

19 Clark TW, "Complications of hepatic chemoembolization" 23 : 119-125, 2006

20 Sharma P, "Bone mineral density predicts posttransplant survival among hepatocellular carcinoma liver transplant recipients" 22 : 1092-1098, 2016

21 Stidham RW, "Body fat composition assessment using analytic morphomics predicts infectious complications after bowel resection in Crohn's disease" 21 : 1306-1313, 2015

22 Singal AG, "Body composition features predict overall survival in patients with hepatocellular carcinoma" 7 : e172-, 2016

23 Ryerson AB, "Annual report to the nation on the status of cancer, 1975-2012, featuring the increasing incidence of liver cancer" 122 : 1312-1337, 2016

24 Englesbe MJ, "Analytic morphomics, core muscle size, and surgical outcomes" 256 : 255-261, 2012

25 Mathew J, "Adherence to the BCLC guidelines and impact on overall survival" 32 (32): 2014

26 Harbaugh CM, "Abdominal aortic calcification and surgical outcomes in patients with no known cardiovascular risk factors" 257 : 774-781, 2013

27 Kadalayil L, "A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer" 24 : 2565-2570, 2013