title: Visceral fat area predicts survival in patients with advanced hepatocellular carcinoma treated with tyrosine kinase inhibitors.
abstract: BACKGROUND
  Anthropometric measurements have been linked to resistance to anti-angiogenic treatment and survival.
  
  
  METHODS
  Patients with advanced hepatocellular carcinoma treated with sorafenib or brivanib in 2008-2011 were included in this retrospective study. Anthropometric measurements were assessed using computed tomography and were correlated with drug toxicity, radiological response, and overall survival.
  
  
  RESULTS
  52 patients were included, Barcelona Clinic Liver Classification B (38%) and C (62%), with a mean value of α-fetoprotein of 29,554±85,654 ng/mL, with a median overall survival of 10.5 months. Sarcopenia was associated with a greater rate of hand-foot syndrome (P=0.049). Modified Response Evaluation Criteria In Solid Tumours (mRECIST) and Choi criteria were significantly associated with survival, but RECIST criteria were not. An absence of hand-foot syndrome and high-visceral fat area were associated with progressive disease as assessed by RECIST and mRECIST criteria. In multivariate analyses, high visceral fat area (HR=3.6; P=0.002), low lean body mass (HR=2.4; P=0.015), and presence of hand-foot syndrome (HR=1.8; P=0.004) were significantly associated with overall survival. In time-dependent multivariate analyses; only high visceral fat area was associated with survival.
  
  
  CONCLUSIONS
  Visceral fat area is associated with survival and seems to be a predictive marker for primary resistance to tyrosine kinase inhibitors in patients with advanced hepatocellular carcinoma.
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Liver Unit, Henri Mondor Hospital, Créteil, France.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Nault
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Department of Radiology, Henri Mondor Hospital, Créteil, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pigneur
authors.affiliation: APHP, Groupe Hôpital Européen Georges Pompidou, Department of Clinical Research, Paris, France; INSERM, UMRS 1138, Team 22, Department of Research of Les Cordeliers, Paris, France; University Paris 5 René Descartes, Paris, France.
authors.forename: Anaïs Charles
authors.initials: AC
authors.lastname: Nelson
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Liver Unit, Henri Mondor Hospital, Créteil, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Costentin
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Department of Radiology, Henri Mondor Hospital, Créteil, France.
authors.forename: Lambros
authors.initials: L
authors.lastname: Tselikas
authors.affiliation: APHP, Groupe Hôpital Européen Georges Pompidou, Department of Clinical Research, Paris, France; INSERM, UMRS 1138, Team 22, Department of Research of Les Cordeliers, Paris, France; University Paris 5 René Descartes, Paris, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.affiliation: Department of Statistics, George Mason University, Fairfax, VA, USA.
authors.forename: Guoqing
authors.initials: G
authors.lastname: Diao
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Department of Hepatobiliary Surgery, Henri Mondor Hospital, Créteil, France; University Paris Est Créteil, Créteil, France; INSERM U955, Team 18, Créteil, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Laurent
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Liver Unit, Henri Mondor Hospital, Créteil, France; University Paris Est Créteil, Créteil, France; INSERM U955, Team 18, Créteil, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Mallat
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Liver Unit, Henri Mondor Hospital, Créteil, France; University Paris Est Créteil, Créteil, France; INSERM U955, Team 18, Créteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Department of Radiology, Henri Mondor Hospital, Créteil, France; University Paris Est Créteil, Créteil, France; INSERM U955, Team 18, Créteil, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Luciani
authors.affiliation: APHP, Groupe Henri Mondor Albert Chenevier, Liver Unit, Henri Mondor Hospital, Créteil, France; University Paris Est Créteil, Créteil, France; INSERM U955, Team 18, Créteil, France. Electronic address: tdecaens@chu-grenoble.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Decaens
mesh_terms: D000368:Aged; D000409:Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005602:France; D060831:Hand-Foot Syndrome / Q000150:complications*; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D055948:Sarcopenia / Q000150:complications; D000077157:Sorafenib; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D014227:Triazines; D000509:alpha-Fetoproteins; D009536:Niacinamide; D000077157:Sorafenib; C509922:brivanib; D000409:Alanine
keywords: Hepatocellular carcinoma; Sarcopenia; Sorafenib; Tyrosine kinase inhibitor; Visceral fat area