Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma.
OBJECTIVE
Obesity defined by body mass index (BMI) significantly increases the risk of hepatocellular carcinoma (HCC). In contrast, not only obesity but also underweight is associated with poor prognosis in patients with HCC. Differences in body composition rather than BMI were suggested to be true determinants of prognosis. However, this hypothesis has not been demonstrated conclusively.


METHODS
We measured skeletal muscle index (SMI), mean muscle attenuation (MA), visceral adipose tissue index, subcutaneous adipose tissue index, and visceral to subcutaneous adipose tissue area ratios (VSR) via computed tomography in a large-scale retrospective cohort of 1257 patients with different stages of HCC, and comprehensively analyzed the impact of body composition on the prognoses.


RESULTS
Among five body composition components, low SMI (called sarcopenia), low MA (called intramuscular fat [IMF] deposition), and high VSR (called visceral adiposity) were significantly associated with mortality, independently of cancer stage or Child-Pugh class. A multivariate analysis revealed that sarcopenia (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.18-1.96; p=0.001), IMF deposition (HR, 1.34; 95% CI, 1.05-1.71; p=0.020), and visceral adiposity (HR, 1.35; 95% CI, 1.09-1.66; p=0.005) but not BMI were significant predictors of survival. The prevalence of poor prognostic body composition components was significantly higher in underweight and obese patients than in normal weight patients.


CONCLUSIONS
Sarcopenia, IMF deposition, and visceral adiposity independently predict mortality in patients with HCC. Body composition rather than BMI is a major determinant of prognosis in patients with HCC.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Naoto
N
Fujiwara
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Hayato
H
Nakagawa
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Yotaro
Y
Kudo
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan. Electronic address: tateishi-tky@umin.ac.jp.
Ryosuke
R
Tateishi
Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Japan.
Masataka
M
Taguri
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan.
Takeyuki
T
Watadani
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Ryo
R
Nakagomi
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Mayuko
M
Kondo
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Takuma
T
Nakatsuka
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Tatsuya
T
Minami
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Masaya
M
Sato
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Koji
K
Uchino
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Kenichiro
K
Enooku
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Yuji
Y
Kondo
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Yoshinari
Y
Asaoka
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Yasuo
Y
Tanaka
Department of Radiology, Graduate School of Medicine, The University of Tokyo, Japan.
Kuni
K
Ohtomo
Department of Gastroenterology, Juntendo University, Japan.
Shuichiro
S
Shiina
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Kazuhiko
K
Koike
D050154:Adiposity; D000368:Aged; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D055948:Sarcopenia / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed
Body composition; Body mass index; Hepatocellular carcinoma; Prognosis