Longitudinal Body Composition Identifies Hepatocellular Carcinoma With Cachexia Following Combined Immunotherapy and...

Area of Science:

• Oncology
• Body Composition Analysis
• Cancer Cachexia Research

Background:

• Cancer cachexia negatively impacts prognosis, treatment resistance, and tolerability in hepatocellular carcinoma (HCC).
• Characterizing longitudinal body composition (BC) trajectories is crucial for identifying cachexia in HCC patients.

Purpose of the Study:

• To identify hepatocellular carcinoma (HCC) patients with cachexia by analyzing longitudinal body composition (BC) trajectories.
• To correlate distinct BC trajectories with patient outcomes, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and safety.

Main Methods:

• Longitudinal, multicentre cohort study of unresectable HCC patients receiving first-line systemic therapy.
• Computed tomography (CT) evaluated skeletal muscle mass (SMM) and total adipose tissue area (TATA) at baseline and follow-up.
• Unsupervised latent class growth mixed models identified distinct SMM and TATA trajectories; Cox proportional hazards models assessed survival outcomes.

Main Results:

• Two trajectories identified: sharp-falling and stable. Sharp decline in SMM or TATA defined cachexia.
• Patients were categorized into pre-cachexia (stable BC), cachexia (falling SMM or TATA), and refractory cachexia (falling SMM and TATA).
• Refractory cachexia (5.2%) showed significantly worse OS (11.5 months), PFS (6.0 months), and ORR (4.8%) compared to cachexia and pre-cachexia groups. Refractory cachexia was an independent risk factor for OS and PFS.

Conclusions:

• Longitudinal BC trajectories effectively identify cachexia and refractory cachexia in HCC patients.
• Falling BC trajectories, particularly in refractory cachexia, are linked to poorer treatment response, survival, and tolerability.
• These findings highlight the prognostic significance of body composition changes in HCC management.