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CT Body Composition Changes Predict Survival in Immunotherapy-Treated Cancer Patients: A Retrospective Cohort Study
Shlomit Tamir1,2, Hilla Vardi Behar3, Ronen Tal3
1Radiology Department, Rabin Medical Center-Beilinson Hospital, Petah Tikva 49100, Israel.
Cancers
|January 28, 2026
Summary
Declines in skeletal muscle and subcutaneous fat during immunotherapy predict mortality in cancer patients. Automated CT analysis of body composition changes can aid treatment decisions.
Area of Science:
- Oncology
- Radiology
- Body Composition Analysis
Background:
- Computed tomography (CT)-derived body composition parameters are prognostic in oncology.
- Changes during treatment may offer greater prognostic value than baseline measures.
- Standardized methods for CT-based body composition analysis are limited.
Purpose of the Study:
- To evaluate the prognostic value of longitudinal changes in CT-derived body composition parameters.
- To assess the association between body composition changes and mortality in patients treated with immunotherapy.
- To introduce a novel automated software for body composition analysis.
Main Methods:
- Retrospective study of 376 patients with NSCLC, RCC, or melanoma treated with immunotherapy.
- Analysis of baseline and follow-up CT scans using automated software (CompoCT) for L3 slice selection and segmentation.
- Calculation of body composition indices, including skeletal muscle index (SMI) and subcutaneous fat index (SFI).
Main Results:
- Baseline body composition parameters showed limited association with mortality; only higher SMI had a weak protective effect.
- Longitudinal decreases in SMI (HR=1.17) and SFI (HR=1.11) were strongly associated with increased mortality.
- Multivariate analysis identified older age, NSCLC, and relative decreases in SMI and SFI as independent predictors of mortality.
Conclusions:
- Longitudinal decreases in skeletal muscle and subcutaneous fat are independent predictors of mortality in immunotherapy-treated patients.
- Automated CT-based body composition analysis can provide valuable prognostic information.
- These findings may support treatment decisions and patient monitoring during immunotherapy.
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